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Running head: MSN GERONTOLOGICAL COMMUNITY-ACADEMIC PARTNERSHIP 1

Gerontological Community-Academic Partnership for an MSN Internship

Francine Serafin-Dickson

University of San Francisco

Committee Chairperson

Timothy Godfrey, SJ, DNP, MSW, RN

Committee Member

Wanda Borges, PhD, RN

December 2017

MSN GERONTOLOGICAL COMMUNITY-ACADEMIC PARTNERSHIP 2

Acknowledgements

My life journey started with my parents, as we all begin. I dedicate this work in memory

of my parents, Camilla Mondelli and Frank Serafin, children of immigrants who never had the

academic opportunities they afforded me. They instilled in me perseverance, a tremendous work

ethic, and a heart to always care for others. Thus, based on their hard work and direction I

started my academic journey at the University of San Francisco (USF) and now finished my

terminal degree 46 years later.

Immense thanks to my husband, Mark, for his love, patience, and support while I sat

many long days in front of the computer and for his IT prowess, and to my two adult children,

Rachael and Madeline, for their amazement, appreciation, and understanding of my life as a

nurse and my days as a graduate student.

Much gratitude to my dear Committee Chair, Rev. and Dr. Timothy Godfrey, SJ, who

was there for me at any time during my DNP journey. His scholarly and soulful guidance and

empathetic support are appreciated beyond words. Thanks to Dr. Wanda Borges, my committee

member, who prodded me to start the DNP journey and guided me through the operational

practicalities of this project. Both continually shared my passion for older adults and a sense of

humor to keep the momentum going.

My co-faculty and professors at USF cheered me on, responded to my many questions,

and helped me problem-solve throughout my project. Thanks to Drs. Elena Capella, Cathy

Coleman, Margaret Levine, Mary Lou DeNatale, Lisa Sabatini, Nancy Taquino, Helen Nguyen,

Mary Seed, Chenit Ong-Flaherty, Brian Budds, Nancy Selix, and Juli Maxworthy, and Claire

Sharifi, USF librarian. I also wish to thank Dr. Judy Karshmer, an inspirational visionary, who


supported me during my teaching time at USF and who also prodded me to start this journey. I

am honored to be associated with every one of you.

Last, but definitely not least, thanks from the bottom of my nursing heart to my own

“nursing sorority” of colleagues and a select cadre of friends for over 40 years. As they give

daily back to the world, they also shared this journey with me with curiosity and support: Cecilia

Cadet, Theresa Levinson, Cheri Bianchini, Judy Kaufman, Janet Abelson, Patrice Christensen,

Joan Mersch, and Andrea Zoodsma.

Finally, thanks to every patient and client that I have encountered in my nursing lifetime,

whether lying in a hospital bed or living in the community, they have reinforced daily why I

chose this professional and taught me what I could not find between the covers of a textbook or

sitting in a classroom.


TABLE OF CONTENTS

Section I. Title and Abstract

Title………………………………………………………………………… 1

Acknowledgments…………………………………………………………. 2

Abstract……………………………………………………………………. 7

Section II. Introduction

Problem Description………………………………………………………. 8

Description of Setting………………………………………………. 10

Available Knowledge………………………………………………………. 10

Project Frameworks……………………………………………………........ 18

Aim Statement ………………………………………………………………. 20

Section III. Methods

Context………………………………………………………………………. 21

Interventions…………………………………………………………………. 22

Gap Analysis……………………………………………………......... 23

Project Milestones………………………………………………......... 24

Work Breakdown Structure…………………………………………... 24

SWOT Analysis………………………………………………………. 25

Communication Matrix ………………………………………………. 26

Cost-Avoidance/Benefit Analysis……………………………….......... 27

Study of the Interventions……………………………………………………… 28

Measures………………………………………………………………………. 28

Analysis………………………………………………………………………. 29


TABLE OF CONTENTS (cont.)

Ethical Considerations………………………………………………………. 29

Section IV. Results………………………………………………………………… 30

Section V. Discussion

Summary……………………………………………………………………. 37

Interpretation………………………………………………………………... 38

Issues………………………………………………………………………… 40

Limitations…………………………………………………………………. 42

Conclusions…………………………………………………………………. 43

Section VI. Funding………………………………………………………………. 44

Section VII. References……………………………………………………………. 45

Section VIII. Tables

1. Facts on Aging Quiz Baseline (Pre-Semester) Results…………………. 54

2. Facts on Aging Quiz Post-Semester Results……………………………. 56

3. Aging Semantic Tool Results Baseline Results………………………… 58

4. Aging Semantic Tool Post-Implementation Results…………………… 59

5. Students’ Reflection Questions Responses …………………………… 60

6. Community Agency Survey Results……………………………………. 62

Section IX. Appendices

A. Statement of Determination and Non-Research Approval Documents… 63

B. Literature Appraisal Tools

B1 John Hopkins Research Evidence Appraisal Tool…………………. 66

B2. John Hopkins Non-Research Evidence Appraisal Tool…………... 69

C. Evaluation Table of the Literature……………………………………... 72


D. Letter of Support from Academic Partner……………………………. 82

E. Improvement Project Roadmap………………………………………. 83

F. Implementation Tools

F1. Gerontological CAP Agency Placement Options………………… 84

F2. Gerontological Curriculum for Community-Based MSN CNL

Internship……………………………………………………………... 85

F3. Gerontological Lectures and Posted Content……………………. 93

G. Gap Analysis…………………………………………………………. 94

H. Gantt Chart…………………………………………………………… 96

I. Work Breakdown Structure…………………………………………... 97

J. SWOT Analysis……………………………………………………… 98

K. Responsibility/Communication Matrix……………………………… 99

L. Cost-Avoidance/Benefit Analysis and Expense Budget……………. 100

M. Data Collection Tools

M1. Facts on Aging Quiz……………………………………………... 101

M2. Aging Semantic Differential Tool………………………………. 104

M3. Student’s Reflection Questions…………………………………. 106

M4. Community Partner Survey……………………………………… 107


Abstract

The growing population of older adults beckons nursing education to evolve and prepare the

future nursing workforce with skills and knowledge to coordinate care for the community-

dwelling older adult (gerontological) population. The purpose of this project is to develop,

implement, and evaluate academic partnerships with agencies serving community-dwelling older

adults for the Master of Science in Nursing (MSN) Clinical Nurse Leader (CNL) students. The

formation of Community-Academic Partnerships (CAP) offers the opportunity for an

experiential learning internship in combination with a gerontological curriculum. The

curriculum is integrated into the CNL role courses and internship, focusing on person-centered

interactions with older adults; the benefits, burdens, and struggles of aging; and the available

services and resources to assist and support the community-dwelling older adults to continue to

age in place. Initial evaluations of the CAP by participating community agencies demonstrated

support and a positive response to the partnership. Students’ initial assessment of their

knowledge of, and attitudes toward, older adults demonstrated a slight increase after one

semester of implementation. The Gerontological CAP serves as a model of how an academic

institution can partner with community agencies that serve older adults to improve the MSN

CNL’s gerontological competencies and attitudes regarding community-dwelling older adults,

and ultimately promote healthy living in the aging population.

Keywords: geriatric/gerontological population, older adults, nursing education, graduate

nursing students, community-academic partnerships, service-learning, community health

nursing, community health partnerships, community partnership building, program effectiveness,

program evaluation, and survey tools.


Gerontological Community-Academic Partnership for an MSN Internship

Section II. Introduction

Problem Description

Older adults, defined as a population of 65 years or older, will account for approximately

20% of the U.S. population by the year 2030 due to longer life spans and aging baby boomers

(Centers for Disease Control [CDC], 2013; US Census Bureau, 2015). The Public Policy

Institute of AARP (2014) reports 87% of older adults want to age in place, defined as the desire

to continue to stay in their current home and community as they age. In response to the

burgeoning older adult population, the National League for Nursing (NLN, 2011) recommends a

transformation of nursing education to care for the older adult population in a holistic,

competent, individualized, and humane manner across all healthcare settings.

The Patient Protection and Affordable Care Act (PPACA) of 2010 directs healthcare

providers to move from care delivery in the acute care setting to population-focused care in the

community. The Institute of Medicine’s (IOM, 2010) report on The Future of Nursing: Leading

Change, Advancing Health intends to realize the objectives of the PPACA by recommending

nursing academia collaborate with healthcare organizations to update curriculum competencies

to meet the increased complexities of patients in their respective care environments. The Tri-

Council for Nursing (2017) poses that RNs need to work collaboratively with community health

workers to focus on the tenets of person-centered coordination of care and population health to

achieve outcomes of health, disease prevention, and chronic disease management.

The CNL program was developed to educate masters-prepared nurses to lead evidence-

based practice change within a microsystem population, addressing safety and quality concerns

in healthcare settings as identified in To Err is Human: Building a Safer Health System (IOM,


1999). The IOM (2008) similarly calls for an increase in the size and capabilities of the

healthcare workforce to develop new models of care for older adults.

Numerous national organizations recommend a transformation of nursing education to

prepare nursing students to provide care for the aging population across all health care settings

(American Association of Colleges of Nursing [AACN], 2010; Hartford Institute for Geriatric

Nursing [HIGN], n.d.; NLN, 2011). Nursing Education Plan White Paper and

Recommendations for California (HealthImpact, 2016) reinforces the need for advancing nursing

education in response to the changing environment through academic partnerships, transition

programs, and community-based residencies. The World Health Organization’s [WHO] (2017)

global strategy and action plan on aging and health affirm that health systems align with the

needs of the older populations. The aging of the population is a driving force for nursing

education to prepare future nurses who understand and can address the health needs of this

population. A Gerontological CAP project incorporates service-learning andragogy within an

MSN curriculum addressing the community-dwelling older adults’ needs.

Discussion of the Local Problem

A gerontological community-based internship and curriculum for MSN CNL students are

currently not available at the University of San Francisco’s School of Nursing and Health

Professions (USF SONHP). A Gerontological CAP provides access to agencies so the MSN

students can learn about the health and care coordination needs of the community-dwelling older

adult population. The Gerontological CAP has a twofold purpose: (1) enhance community

agencies’ capacity to coordinate care and manage older adults’ social determinants of health to

enable them to age in place; and (2) prepare the future MSN CNL nursing workforce to be

competent in coordinating care for community-dwelling older adults (see Appendix A, DNP


Statement of Non-Research Determination Form).

Description of Settings

A Gerontological CAP was developed and implemented at USF SONHP for the 4+1

Bachelor of Science in Nursing (BSN)-MSN CNL students. The 4+1 BSN-MSN program

allows undergraduate students to simultaneously work on an MSN degree and complete the dual

program in as little as five years. The CAP relied on committed community partners who serve

older adult clients in a variety of settings where home is the primary residence (community-

dwelling) for the older adult. An example of the available community services for the student

internship included the following: home care, home health care, palliative care, hospice, adult

day care, rehabilitation short-stay unit, senior peer counseling, care transitions, Meals on Wheels,

dementia services, home case management, a Village, and senior centers.

Available Knowledge

The review of the literature focused on the development, implementation, and evaluation

of CAPs in nursing education, the healthcare sciences, and older adult settings. The electronic

databases utilized in this systematic search process were CINAHL Complete, Cochrane Database

of Systematic Reviews, ERIC, PubMed, Health Source: Nursing/Academic Edition, and the

worldwide web. Only peer-reviewed articles and websites in the English language were

reviewed. Further consideration of evidence was reviewed from the reference lists of relevant

research articles. The following keywords or word strings were used: geriatric/gerontological

population, nursing education, graduate nursing students, community-academic partnerships,

service-learning, community health nursing, community health partnerships, community

partnership building, program effectiveness, program evaluation, and survey tools.


Articles and studies published earlier than 2009 were excluded except the following

seminal publications: four on service-learning, one on partnerships, and three on evaluation tools

to measure students’ attitude and knowledge regarding the older adult population. Three hundred

and nine articles and 27 websites met the inclusion criteria and were reviewed, yielding a total of

27 publications and 27 websites for the review. The John Hopkins Appraisal tools (see

Appendices B1 and B2) were used to critically appraise the quality of the evidence-based articles

for this review (Johns Hopkins Hospital/The Johns Hopkins University, 2012). The review

resulted in eight articles scored and synthesized using the John Hopkins Appraisal tools (see

Appendix C, Evaluation Table of the Literature).

CAP Formation Results. A Gerontological CAP provides an educational experience for

MSN CNL students to learn about the health and care coordination needs of the community-

dwelling older adult population and addresses the knowledge deficit of the student population.

However, the review did not reveal any literature on master’s level nursing gerontological

community-based internships and curriculum. The review did produce articles regarding CAP

formation and corresponding evaluation criteria for undergraduate nursing programs, other

healthcare sciences, and agencies serving older adults.

Nursing education. The implementation of strategic steps to build a framework for a

collaborative CAP that was sustainable and enhanced educational outcomes was found only in

baccalaureate nursing programs (Beauvais, Foito, Pearlin, & Yost, 2015; Kruger, Roush,

Olinzock, & Bloom, 2010; Voss et al., 2015). Measurement of student’s knowledge and

experience were the outcomes cited by all the undergraduate nursing CAPs.

Beauvais, Foito, Pearlin, and Yost (2015) elaborated on the time-intensive steps to

establish a CAP: (1) develop partnership(s), (2) coordinate schedules, (3) set goals for students


and the community agency, (4) implement plans, and (5) develop evaluation metrics. Voss et al.

(2015) used the following action steps to establish a CAP that would identify population health

outcomes and provide benefit to the community agency: (1) create project outline and timelines,

(2) develop mutual and measurable outcomes, (3) manage data by identifying baseline and future

metrics and tools, (4) clarify expectations, and (5) navigate students through the community

agency. Kruger et al. (2009) used a CAP model that immersed faculty and students in the

community, increased capacity at community agencies, responded to community health needs in

a collaborative manner, and partnered with a consistent community or community agency to

build sustainability.

Healthcare sciences. Evidence directed at the formation of CAPs was found in various

applications in the healthcare sciences. Himmelman (2002) describes a community organizing

collaborative framework to build strong partnerships using the sequential strategies of

networking, coordinating, cooperating, and collaborating. Victorian Health Promotion

Foundation (Vic Health, 2016), an Australian organization funded by the Australian Department

of Health, developed a partnership analysis tool to correspond with Himmelman’s framework.

The CDC and the National Business Coalition on Health utilize Vic Health’s synthesis of this

community organizing collaborative framework for health promotion (Himmelman, 2002; Rieker

& Jernigan, 2010).

Clark and Thornton (2014) used the Appreciative Inquiry (AI) approach to build CAPs

for Occupational Therapy students. AI is a collaborative framework where change strategy uses

positive solutions to build upon the current state. AI was used between academia and community

agencies to create a mutual partnership based on the following phases: (1) discovery (2) dream,

(3) design, and (4) destiny.


Community-Campus Partnerships for Health (CCPH, 2013) identifies the following

guiding principles for academia and community partnerships: (a) goal-setting, (b) mutual trust

and respect, (c) capacity building, (d) power balance, (e) open communication, (f) decision-

making and conflict resolution, (g) continuous feedback and improvement, (h) shared

accomplishments, (i) sustainability or dissolution, and (j) value of differences. CCPH states that

these principles can lead to a transformation of the public infrastructure by eliminating health

disparities, building community capacity, and generating new knowledge and evidence. This

transformational example is the intent of the MSN CNL Gerontological CAP.

The AACN-AONE Task Force on Academic-Practice Partnerships Guiding Principles

(AACN, 2012) recommends high-level and detailed approaches to improve the health of the

public by advancing nursing practice in the community. The principles focus on shared

responsibilities from goals through evaluation and quality improvement of the partnership.

Handy and Poor (2016) identify essential elements to address strategic partnerships

among agencies serving the community-dwelling aging population. These elements include the

following: (1) documentation of need, purpose, objectives, and criteria for partnership; (2)

establishment of decision-making, working arrangement, and performance management norms;

(3) identification of barriers and benefits; (4) sharing of learnings; and (5) identification of

process steps unique to the aging field. Strategic partnerships between agencies serving older

adults highlight the need to address specific issues dealing with the aging population.

Kania and Kramer’s (2011) seminal article describes collective impact where

stakeholders from different organizations work together on a common agenda to solve a distinct

social problem for the greater good of society. The tenets of collective impact’s success include

mutually reinforcing activities of shared vision and evaluation, leadership by one supporting


organization, and continuous communication. Collective impact is an emerging collaborative

partnership model applied to community health promotion and has a direct application to this

MSN CNL gerontological community-based internship.

The Administration for Children and Families (ACL; U.S. Health and Human Services,

2012) identifies vital community partnership components similar to the tenets of collective

impact. The ACL uses the following principles to build a successful partnership: (1) leadership,

(2) common understanding of the approach, (3) shared vision and purpose, (4) shared culture and

values, (5) promotion of learning and development, (6) effective communication, and (7)

performance management.

Similarities of Community-Academic Partnership approaches. Similarities of CAP

approaches address steps and organizing principles to develop and sustain a CAP. The analysis

resulted in 100% of the references indicating that development of measurable outcomes was a

principle to be included in CAP development (AACN-AONE, 2012; Beauvais et al., 2015;

CCPH, 2013; Clark & Thornton, 2014; Handy & Poor, 2016; HHS, 2012; Himmelman, 2002;

Kania & Kramer, 2011; Kruger et al., 2010; Voss et al., 2015).

Logistical strategies (including partner contacts), decision-making and communication

structures, and student assignment and oversight were identified by 70% of the references as

fundamental principles in CAPs (CCPH, 2013; Clark & Thornton, 2014; Handy & Poor, 2016;

HHS, 2012; Himmelman, 2002; Kania & Kramer, 2011; Kruger et al., 2010; Voss et al., 2015).

The literature identified documentation of need, purpose, mutual benefits, and barriers 50% of

the time (AACN-AONE, 2012; Beauvais et al., 2015; CCPH, 2013; Clark & Thornton, 2014;

Handy & Poor, 2016; HHS, 2012; Himmelman, 2002; Voss et al., 2015).

The literature also identified the following CAP formation principles, although not as


often, as indicated by the percentage after each principle: (a) partner identification (10%)

(Beauvais et al., 2015); (b) timeline establishment (20%) (Beauvais et al., 2015; Voss et al.,

2015); (c) partnership implementation (20%) (AACN-AONE, 2012; Beauvais et al., 2015); (d)

monitoring and evaluation (20%) (AACN-AONE, 2012; HHS, 2012); (e) sharing of learnings

and evaluation outcomes (40%) (AACN-AONE, 2012; CCPH, 2013; Handy & Poor, 2016;

Himmelman, 2002); (f) process improvement (30%) (AACN-AONE, 2012; CCPH, 2013,

Himmelman, 2002); (g) sustainability, transition, or closure (30%) (CCPH, 2013; Clark &

Thornton, 2014; HHS, 2012); and (h) community capacity building (20%) (CCPH, 2013; Kruger

et al., 2009). The similarities of CAP development served as the basis for formulating an MSN

CNL Gerontological CAP.

Community-Academic Partnership Evaluation. Evaluation of any new program and

partnership is critical for sustainability. Developing an evaluation process based on community

agencies, academia, and students’ outcome needs and expectations serves as ongoing feedback

for modification of this CAP. Evidence-based evaluation components were cited in the literature

for community partners and students involved in CAPs, and for students serving and working

with older adults.

Evaluation of partners. Butterfoss (2009) recommends evaluating at least one measure

between public-private partnerships within the following three levels: (1) infrastructure or

function; (2) targeted activities or goals; and (3) health indicators. For a partnership evaluation

to assist in preventing and managing chronic disease in the community, Butterfoss (2009) cites

specific measures. These evaluation measures include the following: (a) partnership perceptions,

(b) satisfaction with group functioning, (c) clarity of partnership mission and goals, (d) joint

planning of activities, (e) sense of ownership, (f) mutual support, (g) communication,


(h) collective problem-solving, (i) coordination effectiveness, (j) conflict management, (k)

efficacy in managing the partnership process, (l) quality and frequency of interactions, (m)

relationships, and (n) staff performance.

Drahota et al. (2016) conducted a systematic review of research CAPs focusing on the

evaluation of CAP characteristics, the state of the science, outcomes, and factors that facilitate

and hinder the interpersonal and operational collaborative process. The researchers found that

the most common desired outcome among the participants of the CAP (72%), was the

development of a tangible product. For the MSN CNL Gerontological CAP, the students’

culminating quality improvement project would be the tangible product benefitting the

participating community partner.

The facilitating and evaluative factors found in Drahota et al.’s (2016) review that apply

to a MSN CNL Gerontological CAP are the following: (a) trust; (b) respect; (c) shared vision,

mission, and/or goals; (d) good relationships; (e) effective and/or frequent communication; (f)

well-structured meetings; (g) clear roles/functions; (h) leadership; (i) effective conflict

resolution; (j) good selection of partners; (k) community impact; and (l) mutual benefit. The

hindering factors found in their review, which can also apply to a CNL Gerontological CAP are

the following: (a) excessive time commitment; (b) unclear roles/functions; (c) poor

communication; (d) inconsistent participation; (e) burdensome tasks; (f) lack of shared vision,

mission, and goals; (g) differing expectations; (h) mistrust; (i) lack of common or shared

language; and (j) bad relations.

Vic Health (2016) utilizes a checklist to evaluate partnerships in health promotion across

varied sectors in the community. The checklist items are generally categorized under the

following: (1) need for the partnership, (2) choosing partners, (3) making sure partnerships work,


(4) planning collaboration, (5) implementing collaboration, (6) minimizing barriers, and (7)

reflection and sustainability.

Caron, Ulrich-Schad, and Lafferty (2015) developed a survey tool to evaluate the

effectiveness of public health, community groups, and schools working together to reduce public

health concerns and issues. Characteristics evaluated in the survey included the following:

(a) shared goals, (b) communication, (c) overall effectiveness, (d) mutual benefit, (e) challenges,

(f) outcomes, and (g) sustainability.

Voss et al. (2015), in an undergraduate gerontological nursing practicum with

community-dwelling older adults, identified client outcomes as a means to measure service-

learning within CAPs. The outcomes included improvement in the clients’ quality of life, health

literacy, access to resources, the perception of improvement in overall health, and specific health

metrics.

Similarities of partner evaluation criteria. Although there are many articles focused on

CAPs in health care or for the gerontological population, only four articles focused on the

evaluation of CAPs in academia or health care. Group functioning and collaboration, shared and

clear goals, process effectiveness, and mutual support and benefits appeared in all four of the

articles (Butterfoss, 2009; Caron, Ulrich-Schad, & Lafferty, 2015; Drahota et al., 2016; Vic

Health, 2016). Three articles used the following evaluation criteria to measure the progress and

success of the CAP: (a) quality and frequency of communication, (d) collective problem-solving

and conflict management, and (c) role clarity (Butterfoss, 2009; Drahota et al., 2016; Vic Health,

2016). Three of the articles mentioned the following criteria for evaluation: (a) partnership

perceptions of trust and respect, (b) coordination effectiveness, (c) staff performance, and

(d) challenges (Butterfoss, 2009; Caron et al., 2015; Drahota et al., 2016). Caron et al. (2015)


and Vic Health (2016) were the only authors who mentioned sustainability. Tangible outcomes

as evaluation criteria were highlighted in two of the articles (Caron et al., 2015; Drahota et al.,

2016). Only one of the authors mentioned the need for reflection (Vic Health, 2016).

Evaluation of students. Three tools were used to evaluate students from six

undergraduate nursing practicums with community-dwelling older adults. The three tools

focused on knowledge, attitudes, and skills during and after a Gerontological CAP immersion.

Student reflections were used in four out of the six programs (Clemmens et al., 2009; Ezeonwu,

Berkowitz, & Vlasses, 2014; Trail Ross, 2012; Voss et al., 2015); Kogan’s Attitudes toward

Older People’s Scale and Palmore’s Facts on Aging Quiz were used in two of the six programs

(Beauvais et al., 2015; Lee, Wong, & Loh, 2006).

One undergraduate nursing program conducted a formative evaluation while students

were placed in various community settings over four semesters (Kruger et al., 2010). This

formative evaluation focused on the following indicators of student knowledge: (a) health

promotion, (b) prevention, (c) upstream approaches, (d) inter-professional collaboration, (e)

communication, (f) teaching advocacy, (g) responsibility, (h) diversity, (i) community resources,

and (j) a big picture vantage point.

Similarities of student evaluation criteria. Student survey tools evaluated students’

knowledge and attitude of older adults. The evidence directed the DNP student to choose two

quantitative evaluation tools for the Gerontological CAP for the MSN CNL program. In-class

and reflection questions served as another means to assess students’ learning experiences.

Rationale: Project Frameworks

Two frameworks, one theoretical and one conceptual, guided the development,

implementation, and evaluation of this gerontological community-based curriculum and


internship. Service-learning is a theory developed in the early twentieth century and the

Advancing Care Excellence for Seniors (ACES) is a conceptual framework developed 100 years

later. The combination of these two frameworks formed the foundation for this project.

Service-Learning. Service-learning is a theoretical framework which combines John

Dewey’s social and educational philosophies and focuses on citizenship, community, and

democracy (Giles & Eyler, 1994). Giles and Eyler further explained that Dewey believed

education through democracy could build social intelligence and support for the local

community. Mitchell (2008), as well as Gillis and Mac Lellan (2010), emphasize social justice

issues, application of knowledge, and community engagement as critical aims of service-

learning.

Service-learning is a powerful instructional methodology that links and applies theory

and knowledge from the classroom to real-life settings in the community (Eyler & Giles, 1999).

Service-learning is found within partnerships between academia and community agencies

resulting in the mutual benefit to the community and the students. A similar emphasis centers on

student reflections regarding the context where they provide the service while they apply their

didactic and service learning (Community-Campus Partnership for Health, 2007; Pew Health

Professions Commission, 1998; Seifer, 1998). Service-learning in the health professions is an

outcome of the 1995 Pew Health Professions Commission’s Health Professions Schools in

Service to the Nation demonstration project (Seifer, 1998).

Service-learning served as the andragogic framework for this community-based MSN

CNL Gerontological Internship. The definition and aims of service-learning are the drivers and

outcome measures for creating CAPs for this new emphasis within the MSN CNL internship.


Advancing Care Excellence for Seniors (ACES). The ACES conceptual framework

was developed jointly in 2010 by the NLN and the Community College of Philadelphia (NLN,

2011). The aim of ACES is to enhance nursing students’ learning, identify ways to translate their

knowledge for community-dwelling older adults and promote positive perceptions of aging. The

ACES framework includes three components: (a) the learning environment, (b) essential nursing

actions, and (c) essential knowledge domains. The essential knowledge domains are

individualized aging, complexity of care, and vulnerabilities during life transitions. The essential

nursing actions include the following: Access function and expectations; Coordinate and

manage care; use of Evolving knowledge; and make Situational decisions (NLN, 2016;

Tagliareni, Cline, Mengel, McLaughlin, & King, 2012).

The ACES framework guided the development of the MSN CNL Gerontological

Community-Based (learning environment) course description and objectives. The purpose of the

course was intended to enhance students’ knowledge (essential knowledge domains) and skill

application (essential nursing actions) regarding older adults’ health needs while also developing

an understanding of the social determinants of and community resources for this population.

AIM Statement

The aim statement of this DNP project was to develop, implement, and evaluate a new

Gerontological CAP for USF’s 4+1 BSN-MSN CNL internship using seven community agencies

as partners by summer semester 2017. A two-step process was integrated into the project to

accomplish this aim. The first step was to incorporate service-learning andragogy and

gerontological curriculum into the CNL role courses and internship to meet the growing

population of community-dwelling older adults’ health needs. The other step was to ultimately


expand learning and workforce opportunities for USF MSN CNL students in non-acute care

settings providing services for community-dwelling older adults.

Section III. Methods

Context

The key stakeholders for this project were the USF SONHP leadership team, executives

at the community agencies serving older adults, the 4+1 BSN-MSN students doing their CNL

internship in the community agencies, and the older adult clients receiving the services.

Direction and authorization for this project were given by the SONHP Dean and Associate Dean

to prepare MSN CNL students to manage and coordinate community-dwelling older adults’

health needs in order to allow them to age in place (see Appendix D for Letter of Support from

Academic Partner). Faculty from the MSN program were briefed on the potential for this new

program and queried as to the best MSN CNL cohort(s) to place in this Gerontological CAP

internship. Faculty agreed to place the 4+1 BSN-MSN students into the initial CAP since they

were not already immersed in a practicum site for their CNL internship.

After USF SONHP direction and authorization, the DNP student contacted and met with

twelve community agencies serving community-dwelling older adults in a variety of settings

where home is the primary residence (community-dwelling) for the older adult. Ten agencies

had never had USF students. Eight agencies welcomed the idea of having students placed in their

agencies, after in-person meetings and written communication was shared, regarding the new

Gerontological CAP. Thus, subsequent authorization to partner came from executives at the

interested community agencies who serve older adult clients. The following non-profit

community agencies were offered as choices to the 4+1 BSN-MSN CNL students for their CNL

internship placement: (a) two hospices and home health agencies, (b) two social support


agencies, (c) one nutritional support agency, (d) one voluntary health organization, and (e) one

Village, a membership organization offering social services to community-dwelling older adults

to assist them to age in place.

Interventions

The quality method that guided this project was the Institute for Healthcare

Improvement’s (IHI) Improvement Project Roadmap (see Appendix E for the IHI Improvement

Project Roadmap [IHI, 2017]). After the initial step of the DNP project choice and authorization,

an aim statement was developed per step one of the IHI Project Roadmap. The review of the

literature and the current settings provided the basis for the development of an improvement

strategy reflecting the second step of the Roadmap. The process steps to implement the

Gerontological CAP was developed as the third step. Step four of the Roadmap is

implementation and performance monitoring. Implementation of this project included the

placement of students in the community agencies and integration of the gerontological

curriculum into the CNL role courses. Evaluation tools were chosen, developed, and used to

monitor the implementation. Once the MSN CNL three-semester internship is completed, and

full evaluation has occurred, the new program can be implemented in other programs within USF

SONHP which reflects the final step of the Roadmap, “spread the new standard through the

system” according to IHI (2017, pg. 4) Improvement Project Roadmap.

The DNP student, the developer and faculty of record for the CNL Role course for the

chosen 4+1 BSN-MSN CNL cohort, met with the seven students two months prior to their CNL

internship placement. The introduction to this new program included the rationale for the course,

the CNL course curriculum, and the potential community agency placement sites. Four of the

seven students chose their CNL placement site from the available options (see Appendix F1 for


Community Agency Options), then the DNP student introduced each student to his or her

partnering community agency.

The original community partner contacts had received a verbal in-person and written

overview of the Gerontological CAP to inform them of this new program at USF SONHP. The

overview outlined the CAP intent, expectations, and deliverables so they could decide if they

wished to participate. Based on the communication, seven agencies agreed to participate. Once

the students chose their placement site from a list of the interested community agencies, an email

was resent to the community partners and designated community preceptors describing the three-

semester MSN CNL curriculum objectives, an introduction to the student and the role, and the

expectations of the agency.

The gerontological course content supplemented the CNL role courses and

complemented the service-learning experience (see Appendix F2 for Gerontology Community-

Based Curriculum Plan and Appendix F3 for Gerontological Lectures & Content). The DNP

student created and taught the gerontological curriculum as well as supervised the Gerontological

CAP nursing internship.

The gerontological curriculum served as the basis for the delivery of four gerontological

lectures during the semester and posting of gerontological course references in Canvas, USF’s

online learning management system. The intervention of didactic lectures combined with

service-learning at the community agencies sought to prepare the students to lead the

coordination of care for community-dwelling older adults with the intent to enable the older adult

population to age in place.

Gap Analysis. A formal gap analysis for this project determined the need and possible

outcomes for USF SONHP, the students, and agencies serving community-dwelling older adults.


The chief gap was a lack of a gerontological community-based internship and curriculum for

USF MSN CNL students to prepare them to meet the population health needs of community-

dwelling older adults. A gerontological community-based graduate MSN internship was not

found in the literature, yet similar nursing undergraduate and other health disciplines internships

provided processes to close the gap (see Appendix G for Gap Analysis).

Project Milestones. Community collaborative approaches identified the phases for the

Gerontological CAP (Himmelman, 2001; Clark & Thornton, 2014). The following five CAP

phases guided this project: (1) discovery and assessment, (2) dream and network, (3) design and

coordinate, (4) cooperate and execute, and (5) collaborate, evaluate, and sustain (see Appendix H

for Gantt Chart). After initial meetings with the academic and community partners, specific

steps within each phase incorporated the best practices found in the literature for development of

a CAP (AACN-AONE, 2016; Caron et al., 2015; Clark & Thornton, 2014; Community-Campus

Partnerships for Health, 2013; Handy & Poor, 2016; Himmelman, 2001; U.S. Department of

Health & Human Services, 2012). The phases and corresponding steps guided the planning,

implementation, and evaluation for the establishment of a mutually-beneficial Gerontological

CAP and service-learning experience for the MSN CNL students and the community agencies

serving the older population. The critical milestone steps outlined in the Gantt chart proceeded

according to schedule as evaluation was completed after the first semester of the project, ending

August 2017.

Work Breakdown Structure (WBS). The CAP project encompassed the following four

critical resources to the success of a CAP: (a) academic partner, (b) community partners,

(c) students, and (d) curriculum. The tasks within each resource overlapped into each other to

achieve the desired outcomes for the Gerontological CAP. The DNP student collated the


partners’ and students’ evaluations and reported to the academic and community partners. The

delivery of lectures by the DNP student was the end task of the gerontological curriculum

resource requirement. Essential tasks were accomplished for each resource entity and coincided

with the high-level milestones for a Gerontological CAP (see Appendix I for WBS).

SWOT Analysis. New program development relies on authorization and support from

key stakeholders based on an identified need. Stakeholder alignment is one of the key strengths

in developing a Gerontological CAP (AACN-AONE, 2012; CCPH, 2013; Clark & Thornton,

2014; Handy & Poor, 2016; Himmelman, 2002). The following identified strengths were

realized during the implementation: (a) evidence of establishing Gerontological CAPs in

undergraduate nursing programs; (b) gerontological and partnership knowledge experts at USF;

and (c) a broad spectrum of gerontological services among potential community partners.

Opportunities in establishing a Gerontological CAP for MSN CNL students were

multiple. Mutual learning and collaboration between the academic and community partners were

foundational components. Student opportunities could go beyond just the opportunity to develop

a quality improvement project; students’ job opportunities would hopefully be enhanced due to

their increased knowledge of the older adult population needs and complementary social

services. This new model could similarly serve as a marketing tool for SONHP and eventually

spread to other SONHP graduate programs. The ongoing benefit to students, community

agencies, and community-dwelling older adult clients were identified as significant strengths and

could expand opportunities for community agencies and future nurses (see Appendix J for

SWOT Analysis).

A CAP cannot be established without interested, committed, and satisfied partners nor

sustained without ongoing partnerships. The following weaknesses of a CAP could be: (a) lack


of responsiveness from potential community partner(s); (b) lack of evidence in the literature of

Gerontological CAPs at the graduate level; and (c) lack of interest and commitment from

community agencies. A potential weakness could be a lack of interest among faculty to teach

and sustain the Gerontological CAP once established.

Once the community agencies committed to a partnership, the following potential threats

were identified for evaluation: (a) communication breakdown between the academic and

community partners; (b) inadequate understanding of the community agency’s role and

responsibilities; (c) turnover of key stakeholders at a community agency; (d) partnership

breakdown due to the withdrawal of a community partner; (e) resources to sustain partnership

become unavailable; (f) lack of preceptor(s) in the community agencies; (g) lack of SONHP

support; (h) students’ lack of interest/passion for older adults; and (i) interpersonal conflicts

between student and preceptor (see Appendix J for SWOT Analysis).

One of the vital communication issues could be the lack of clarity and agreement for the

CAP strategic relationship (Handy & Poor, 2016). The DNP student developed verbal and

written communication before student placement and defined the following elements: (1)

purpose; (2) mutual goals and expectations; (3) communication strategies and structures; (4)

timelines; (5) curriculum objectives; and (6) evaluation metrics to measure progress and value.

To address a myriad of potential communication issues during the CAP, ongoing progress

meetings and prompt response to questions or concerns from the partners were incorporated into

the implementation.

Communication Matrix. The DNP student facilitated the communication among

SONHP, the community partners, and the students immersed in the Gerontological CAP (see

Appendix K for Responsibility/Communication Matrix). The DNP student determined the final


community partners, assigned the students, served as the CAP coordinator, and served as the

primary contact from USF SONHP. Also, the DNP student taught the CNL courses where the

gerontology curriculum was embedded utilizing the Gerontology Community-Based Curriculum

Plan objectives. The DNP student conducted the student and CAP evaluations. The SONHP,

community partners, and students received ongoing feedback on the progress of the CAP and

evaluation outcomes.

Cost-Avoidance/Benefit Analysis. The development of the CAP and gerontology

curriculum took approximately 18 months. The implementation of the CAP began with the

development of the gerontology curriculum and community agency meetings. The budget to

develop, implement, and evaluate the new CAP program was estimated at $60,000 for six

semesters.

The potential costs of this project were based on meetings to develop the CAP program,

faculty pay and travel for six semesters, research assistant’s time to assist in the collection and

analysis of the evaluations, and supplies. The potential return on investment was based on the

following: (a) increasing enrollment of one student in USF SONHP MSN CNL program due to

the opportunity to be immersed in a gerontological community-based internship; (b) preventing

one potential hospital admission of a fall in a community-dwelling older adult (California Office

of Statewide Health and Planning Development, 2012); and (c) increasing capacity at the

community agency through a student-developed quality improvement project. The CNL student

will develop, implement, and evaluate an improvement or change in an agency’s process during

their final, third semester to benefit the agency. A potential positive bottom line financial

balance of $233,410 was anticipated based on the cost avoidance of one community-dwelling

older adult not falling, a possible student quality improvement project, and the return on


investment to USF SONHP and the partnering community agencies (see Appendix L for Detailed

Budget, Cost Avoidance, and ROI analysis).

Study of the Interventions

Multiple approaches were used to assess the impact of the Gerontological CAP program.

Two quantitative tools were utilized pre- and post-semester to measure students’ knowledge and

attitude regarding older adults. The Facts on Aging (FAQ) quiz was used to measure students’

knowledge acquisition, and the Aging Semantic Differential (ASD) tool was used to measure

their attitudes toward older adults. Items in the FAQ and ASD tools reflect population health

needs of older adults that can be used in developing learning outcomes for nursing students

coordinating care for community-dwelling older adults. Qualitative feedback was elicited from

students’ reflections answering structured questions at the end of the semester. The reflection

questions were based on a review of the literature. A CAP partner survey tool was based on the

CAP evaluation criteria found in the literature review.

Measures

The project utilized input from students and community partners to assess the

effectiveness of the curriculum and the CAP. The DNP student used the following metrics:

1. Number and types of community partners, including the number of new SONHP

placement sites.

2. Students’ placements.

3. Students’ knowledge of and attitudes toward older adults.

4. Student Reflections.

5. Students’ evaluations of CNL community placement.

6. Community partners’ response to the CAP.


7. Preceptors’ evaluations of the CNL students.

Analysis

Microsoft Excel was used to tabulate and analyze the data from the FAQ and ASD

measurement tools. The qualitative data from the student reflection questions, the community

partner CAP surveys, CNL course evaluations by the students and preceptors, and ongoing

process feedback was manually summarized. The number of CAPs was tabulated and described.

Ethical Considerations

The mission of USF, a Catholic Jesuit institution of higher learning, “offers students the

knowledge and skills needed to succeed as persons and professionals, and the values and

sensitivity necessary to be men and women for others” (USF, 2001, para. 1). The mission of the

SONHP “advances USF’s mission by preparing health professionals to address the determinants

of health, promote policy and advocacy, and provide a moral compass to transform health care”

(USF, n.d.-b). The development of the Gerontological CAP bridged these two missions by

incorporating the following into the 4+1 CNL curriculum: (a) determinants of health of older

adults, (b) advocacy for older adults to age in place, and (c) transforming health care to look

beyond the walls of an acute care setting into the community.

The Jesuit values embedded in USF’s mission has served as the ethical foundation for the

development of the CAP. The mission reinforced to the students how to be women and men who

provide care coordination for older adults to function at their optimal capacity in their own

homes. Thus, the development of the CAP assisted the students to learn how to do for others.

The American Nurses Association (ANA) Code of Ethics (COE) provides ethical tenets

for the nursing profession to be accountable and guide analysis, decision, and action. Many

ANA COE provisions applied directly to this Gerontological CAP as students were placed in


community agencies, beyond individual patient encounters in acute care settings, and reinforced

USF’s mission. It is the responsibility and obligation of the nursing profession to develop

creative solutions to assist the community-dwelling older adults to live healthy lives as they age

by applying the ethical principles of beneficence and veracity per ANA COE Provision 4.2

(ANA, 2015). As in any encounter with a patient or client, nurses are accountable to each

person’s dignity and unique attributes, and need to find out what matters to the client as

described in ANA COE Provision 1.1 (ANA, 2015). As in the case of the older adults, nurses

need to be aware of and accountable to address complex health issues and life transitions by

advancing a healthy environment for this population per ANA COE Provision 8.3 (ANA, 2015).

Collaboration with other health professionals to advocate and promote health is explained in

ANA COE Provisions 1.5 and 3.1 (ANA, 2015), were tools employed to assist the student to

intervene on behalf of the older adult. Also, nurses need to commit to the value of healthy aging

based on evidence-based practice (WHO, 2017).

The student evaluation tools were discussed with the USF SONHP Associate Dean for

Graduate Programs and Community Partnerships. The DNP student and the Associate Dean

determined the project did not require the university institutional review board (IRB) approval as

it met an evidence-based change in practice (see Appendix A for Evidence-Based Change of

Practice Project Checklist). All results were reported as aggregate data and are not traceable to

any one evaluation participant or agency.

Section IV. Results

For the purposes of this project, the DNP student evaluated only one semester of the

Gerontological CAP. Further evaluations will be conducted during the CNL students’ last two

semesters of their program while doing their CNL role hours at the community partners’ site.


Due to students being at various agencies, this variance was controlled by using the same CAP

evaluation with each agency and the same student evaluation tools. The different environments

and venues may explain the varying responses from the students and community partners.

Community Placements

The DNP student contacted ten community agencies to introduce the Gerontological CAP

and inquire about their interest. Two additional community agencies approached the DNP

student with interest to have students at their agency. Two of the twelve agencies were current

SONHP partners. All agencies expressed initial interest. Three agencies requested to postpone

student placement to a future semester due to internal agency staffing issues, one was a current

USF SONHP partner, and the other two were potential new partners. Two of the agencies never

followed up after the initial three to four conversations. Seven partners were remaining and were

offered to the MSN CNL students for placement. The options included two hospices and home

health agencies, two social support agencies, one nutritional support service agency, one Village,

and one voluntary health organization.

Student Placement

Four students agreed to be placed in one of the community agencies and chose the

following placements: (a) a social service agency that serves older adults in a senior center and

through home case management, (b) two different hospices, and (c) a voluntary health support

organization. The four students were placed in a course with three other CNL students who were

beginning their CNL internship placement and coursework. In addition to the four placed in a

community agency, two students happened to be placed in an inpatient veteran’s hospital caring

for older adults, and one was placed in an operating room setting. Ultimately, seven students


were enrolled in the CNL Role course, where the gerontology curriculum was integrated into the

content. All students participated in the student evaluations.

Student Evaluation Tools

Facts on Aging Quiz (FAQ). Evaluation of students’ knowledge was measured using the

FAQ quiz (Breytspraak & Badura, 2015) which is an update from the original, validated FAQ

(Palmore, 1998). (See Appendix M1 for Facts on Aging Quiz). The FAQ is composed of 50

true/false questions regarding older adults’ physiological, psychosocial, and population health

parameters, with a correct answer for each. The intent was to see an improvement in students’

scores after an SL immersion with older adults and curriculum-embedded gerontological content

to complement the experience of working with older adults.

The baseline data from the FAQ measuring knowledge of older adults was conducted at

the beginning of the semester when the gerontological internship commenced. The baseline

mean score was 69.18/100, the median was 71, and the mode was 100 (see Table 1). Post-

semester data, after the completion of the 80 CNL hours in the student’s internship and receipt of

the gerontological content, the mean score resulted in 74.14/100, with a median of 81.5, and a

mode of 86 (see Table 2). The mean demonstrated a 7.2% increase in knowledge.

Aging Semantic Differential tool (ASD). Attitudes toward older adults were measured

using the ASD tool. The ASD is a reliable tool to measure attitudes toward older adults, and it is

a more relevant and updated tool than other scales found in the literature (Gonzales, Morrow-

Howell, & Gilbert, 2010; Rosencranz, & McNevin, 1969; see Appendix M2 for Aging Semantic

Differential tool). The ASD is the most commonly used instrument in gerontological and

geriatric education and is designed to evaluate the stereotypical attitudes young people have

toward older people (Gonzales, Morrow-Howell, & Gilbert, 2010). Contact with older adults has


shown to influence respondent’s judgments (Rosencranz & McNevin, 1969). The tool is a rating

of 32 opposite behavioral adjectives. Responses to the adjectives are ranked one to seven,

yielding summary scores of 32 to 224; lower scores suggest a more positive view of older adults

and are the intended outcome post-semester implementation.

The baseline data retrieved from the ASD tool was conducted at the beginning of the

semester when the gerontological internship commenced. The mean score was 105 per student

with 32 being the best possible score per student if they choose the more favorable adjective

describing older adults; the worst possible score per student is 224 (see Table 3). Post-semester

mean score per student was 103, a 1% decrease where a lower score is indicative of a positive

variance in attitude (see Table 4).

Reflection questions. The reflection questions focused on the students’ experience

working in a community microsystem serving older adults. The questions, developed by the

DNP student, were centered on the following evidence found in the literature: (1) opportunities

to contribute to the microsystem (Trail Ross, 2012); (2) insights gained from the service-learning

experience (Eyler & Giles, 1999; Trail Ross, 2012); (3) knowledge and skills used in working

with an interdisciplinary team (Eyler & Giles, 1999; Clemmens et al., 2009; Kruger et al., 2010);

and (4) knowledge of community resources which address older adults’ social needs (Eyler &

Giles, 1999; Kruger et al., 2010; see Appendix M3 for Reflection Questions).

The four reflection questions were completed by all seven students (even though one was not

working with older adults) enrolled in the CNL Role course and reflected their qualitative

experience (see Table 5 for Responses to Student Reflection Questions.). The variety of

increased knowledge was due to the diverse placements of the students and are reflected in the

following summary to each question:


1. Contributions to the microsystem: Contributions to the microsystems included the following:

(a) assessment of the microsystem congruent with the CNL role course; (b) productive

interactions with the older adults with the intent to solicit their needs; and (c) the student

contributing a new perspective to the community agency.

2. Insights from SL experience: Insights and learnings gained from the SL internship revolved

around coordination of client needs, system learning, the change process, and workings of a

voluntary community organization.

3. Multidisciplinary teams: The students noted and learned from the following: (a) team

dynamics highlighting the expansive roles of the nurse managers and social workers; (b)

communication interactions among many different disciplines; (c) staff working

interdependently toward a common goal; and (d) active listening enhancing the effectiveness

of an interdisciplinary team.

4. Community resources: The added knowledge of community resources ran the gamut from

the function/role of hospices to community outreach services such as Meals on Wheels and

transportation to home health care services for discharged patients.

Students’ evaluations of CNL community placement. All CNL students submitted a

required course evaluation of their placement at the end of each semester. The students ranked

their learning experience, nursing role models, and diversity of clients on a Likert scale with 7

being excellent/definitely to 1 being poor/not at all. A narrative section of strongest and weakest

points of the placement and overall comments provided further feedback and evaluation input

regarding the Gerontological CAP.

The narrative from student CNL role course evaluations at the end of the semester added

to the qualitative feedback. All students expressed concern that they lacked direct patient care


and interactions. Two of them remarked that they were laying the foundation for the CAP with

social services agencies. The same two students found it challenging to implement the CNL

model while not working with nursing staff.

Community Agencies’ Evaluation

CAP survey. The CAP survey, again developed by the DNP student, measured the

community partners’ experience and perception of the CAP and student intern. The survey

questions were rated on a Likert scale of strongly agree, agree, disagree, strongly disagree, and

not applicable. (See Appendix M4 for the Community Partner Survey). The goal was 80%

agreement using the CAP evaluation tool.

The survey measured satisfaction with the CAP and consisted of 10 questions: six of the

questions focused on collaboration and the student’s role and involvement in the placement,

three questions focused on conflict management, and one question asked if the community

partner reaped any benefits from the CAP. The questions synthesized the CAP evaluation criteria

found in the literature and included the following components (Butterfoss, 2009; Caron et al.,

2015; Drahota et al., 2016; Victorian Health Promotion Foundation, 2016):

a. Mutual goal-setting;

b. Ongoing collaboration and coordination;

c. Role clarity of faculty, agency, preceptor, and students;

d. Quality and timeliness of communication from and with academic partner;

e. Collective problem-solving and conflict management;

f. Challenges recognized and addressed;

g. Successes and benefits to community agency and its clients;

h. Desire to continue the partnership;


i. Mutual identification of student(s) QI project (long-term, CNL semester three);

j. Student’s value to the agency:

i. Student’s initiative,

ii. Student’s dependability, and

iii. Student’s collegiality with staff and clients.

All (four) community partners reviewed the draft survey at the beginning of the semester

and agreed that it reflected their understanding of the CAP program with USF SONHP. The CAP

survey was completed by all four community partners at the end of the semester. The overall

result of agree and strongly agree was 100% on the CAP survey. The satisfaction score goal for

the partnership was 80% agreement, and it was met. The two questions regarding collaboration

were rated 100% strongly agree. The one question regarding the project rationale and student’s

role was rated 75% strongly agree, and 25% agree. The students’ consistent dependability was

ranked 50% in the strongly agree, and 50% in the agree category. Only two of the community

partners rated the conflict management questions, 50% at strongly agree and 50% at agree. The

response to faculty’s timeliness was 100% strongly agree. The rating was 50% in the strongly

agree and 50% in the agree category regarding faculty’s appropriate response and collaboration

to resolve the issue. A student’s identification of client needs was noted as a benefit by one

community agency.

Preceptor evaluations of the CNL students. Another source of feedback from the

community partner was the preceptor evaluation of the CNL students completed at the end of the

semester. The criteria in the preceptor evaluation focus on the student’s interpersonal

relationships, leadership skills, and professional behavior. The criteria related directly to the

CAP thus was used as another evaluation tool. Evaluation of the criteria was assessed using a


met or not met scale. Also, a narrative section for student strengths and areas for improvement

provided additional evaluative input.

The narrative from the preceptor evaluations at the end of the semester added to the

qualitative feedback. The preceptors applauded the students’ initiative, professionalism, and

their ability to see the “big” picture in the real world. There was a concern by two of the

preceptors that the students in their agencies lacked nursing experience which is reflective of

these students who have not finished their BSN degree thus lack nursing work experience.

Section V. Discussion

Summary

Significant value surfaced during the development and implementation of this MSN

Gerontological CAP. The aim of the project was accomplished, albeit only in four community

agencies due to the small number of students and over a short evaluative period of just one

semester. Learnings included gerontological andragogy, responsiveness to a student’s resistance

to the community placement, the need for guidance due to lack of student RN experience, need

for community connections, and clear communication with all stakeholders from inception to

evaluative process during the project implementation.

Student evaluations demonstrated some improvement in knowledge and attitudes

regarding the aging population. The FAQ showed an increase of knowledge at 7.2% from pre-

to post-semester. The slight increase versus a more substantial increase may be due to a lack of

congruency between the gerontological content covered in class and the questions on the FAQ.

In addition, Palmore (1998) asserts the following regarding the proper interpretation and usage of

the outcomes of the original FAQ: (a) use as a discussion tool; (b) use to clarify misconceptions

about aging; (c) use as a measure of the effects of instruction; and (d) consider that the average


person only gets 50% correct, and if a higher score is achieved, the respondent has above average

knowledge regarding aging. The ASD resulted in a 1% positive change which may or may not

indicate an improved attitude toward older adults.

The students’ reflections were thoughtful and reflective of tremendous learnings from

their placements in the areas of interdisciplinary collaboration, coordination of client needs, and

the role of community agencies. One of the gerontological curriculum objectives was that

students were to learn about supportive resources to meet social needs of the community-

dwelling older adults. This objective was met as evidenced by the students’ increased

knowledge of community resources as cited in their reflection responses. The students’

evaluation of the placement showed, however, their concern regarding the lack of direct patient

care and nurse role models while affirming their role in laying the groundwork for a CAP.

Community agency evaluations were affirmative of the project overall, and they agreed

the intent of the CAP was met and looked forward to the students returning the following

semester. Preceptors commented on the initiative and professionalism of the students although

they also registered concern regarding lack of nursing experience of the 4+1 BSN-MSN student.

Interpretation

The literature indicates knowledge, skills, and attitudes towards older adults are critical

components to care for this population and can improve through community immersion

practicums working with older adults (Beauvais et al., 2015; Clemmens et al., 2009; Lee et al.,

2006). Nursing schools need to adjust curriculum so that the student nurses view their role as

community-based nurses extending beyond providing direct care only for individuals to

overseeing processes and outcomes for entire populations (Ezeonwu, Berkowitz, & Vlasses,


2014). Cultural competence in working with older adults in the community also needs to be

integrated into the nursing curriculum (Clemmens et al., 2009; Ezeonwu et al., 2014).

The following critical resources were used in the development, implementation, and

evaluation of the graduate nursing Gerontological CAP: (a) recommendations from USF’s

gerontological and academic partnership experts, (b) nationally recommended curricula from

gerontological educational associations, (c) evidence found in the literature for undergraduate

nursing curricula, and (d) other healthcare disciplines’ curriculum and immersion opportunities

working with community-dwelling older adults. Other resources and recommendations included

the need for connections and subsequent outreach with community organizations serving

community-dwelling older adults, approaches to and evaluation criteria for community

partnership, and valid and reliable tools that measure knowledge and attitudes required to work

with older adults.

The community organizing approaches found in the literature for undergraduate nursing

programs and a variety of other health professions establishing community partnerships served as

a guide for the CAP development, implementation, and evaluation of this project. The ACES

and SL frameworks served as a solid foundation to develop both the gerontological curriculum

and CAP internship. Evaluation results demonstrated the need to place MSN students in a

Gerontological CAP beyond one semester as only incremental learnings of older adults can occur

within one semester.

The two CNL evaluations, preceptor and student, were not originally intended to be used

as measures of the CNL course. Upon completion of the semester, the DNP student realized the

value of the input in these evaluations relating directly to the CAP. Thus, the information was

used as part of the evaluation process.


Issues

The initial SWOT analysis correctly outlined both positive and challenging issues with

the program. Strategies to respond to the weaknesses and threats were mitigated by initial

meetings with the deans and faculty at USF SONHP and the community agencies. The meetings

included an overview of the CAP, the mutual value of addressing community-dwelling older

adult needs, the requirements of time, the need for a preceptor, and the tangible benefit of a

quality improvement project for the community agency (Drahota et al., 2016).

The greatest threat was encountered upfront when meeting with 4+1 CNL students. They

informed the DNP student that they did not want to work with older adults. In addition, the

students also stated they did not want to be put in a “pilot” program and wanted to work in their

own community or their specialty interest, i.e., pediatrics, OB, homeless women shelter, and the

Emergency Department.

The DNP student reminded them that the MSN CNL degree is focused on leadership and

systems improvement not a clinical specialty like a CNS degree. It appeared that most of the

students were not familiar with the CNL role. The students were told that they would be placed

in a community agency when they were admitted into the program, or they could find placement

in their place of employment. Four of the seven students finally acquiesced to a placement in a

Gerontological CAP; two students took a Leave of Absence from the MSN portion of the BSN-

MSN program, one due to only wanting a pediatric placement and the other student for a

personal reason; one found her placement in her place of employment as she did not want to be

placed in a Gerontological CAP and vehemently expressed her views in a written statement.

The two hospice placements have offered a smooth entry for the students which may be

due to the nurse preceptors’ understanding of the role of a nursing student. There were many


interactions between the DNP student and the other two agencies where Medical Social Workers

(MSWs) were the preceptors. The interactions were made to assist the students to get acclimated

to their role as well as the agency, and for the preceptors to understand the purpose of the

students’ program. The latter two agencies also had not had professional students placed within

their agency prior to this CAP. They had heard about the Gerontological CAP and approached

the DNP student for inclusion into the project. Consideration for more faculty involvement is

warranted when students are not placed with an RN preceptor.

The CNL title and program competencies listed on CNL documentation and assignment

forms lack application to community settings. This factor contributed to the students’ confusion

regarding application of the CNL role in the community. USF’s SONHP CNL End-of-Program

Competency Form requires clinical experience encountered in an inpatient setting with the

students evaluating their nursing role models (USF, n. d.-a). The students continually questioned

how the CNL role could transition to a community setting.

The DNP student adopted the “Nurse Leader” role terminology for the students in

community placements as the CNL title is not entirely reflective of the community-setting

interventions. Also, the DNP student continually focused on being a Nurse Leader with clients

in the community and populations, not caring for patients in an acute care setting.

Recommendations to rectify some of these issues include the following:

• The Clinical Nurse Leader title role needs to change to Nurse Leader.

• Program competencies listed on the CNL End-of-Program Competency Form need to be

universally written for clients (indirect care practice roles) who dwell in the community

as well as patients (direct care practice roles) in acute care settings (AACN, 2013).


• Informational sessions to potential 4+1 BSN-MSN students must highlight the following:

(a) the MSN program’s focus is the CNL, not a CNS role; (b) include a description of the

program; and (c) inform the potential students of the agency placements serving

community-dwelling older adults.

• Faculty should interview all MSN CNL applicants who will be placed in a community

setting using structured behavioral questions regarding independence, organizational

skills, and their understanding of the program to determine their level of maturity and fit

for this program.

Limitations

The content from the gerontological curriculum was an addition to the already established

CNL course content, where the CAP served as the internship placement. Due to the full course

CNL course content, there was minimal time for the integration and delivery of the

gerontological curriculum thus only four of the six class meetings addressed gerontological

issues. The evaluations only reflected one semester of implementation. All seven students in

the CNL course received the gerontological curriculum yet only six worked in a community

agency or hospital with older adults during the semester. Four students were placed in

community agencies serving older adults based on the aim of this project; two of these four

students did not have direct contact with older adults although they worked for agencies who

serve community-dwelling older adults. Only four CAP evaluations were received as there were

only four community partners in the program. Overall, the general gerontological curriculum,

one semester of implementation, the small sample size used to evaluate the project, and lack of

students’ consistent exposure to older adults could affect the evaluation outcomes.


Conclusions

The goal of this project was to develop, implement, and evaluate a new Gerontological

CAP for USF’s MSN CNL internship. The CAP was developed based on the principles of

community organizing. A gerontological curriculum was designed and integrated into the MSN

CNL role course. The MSN CNL students were placed in the CAP for one semester with the

goal of having the students complete their subsequent two internship semesters at the same

community sites serving older adults.

The Gerontological CAP exhibited that a combination of CAP sequential steps and an

integrated gerontological didactic course can complement an SL experience in the MSN CNL

internship program. Students showed a slight increase in knowledge of older adults’ needs and

began to learn about the many resources available in the community for adults to assist them as

they age. Community partners were initially intrigued and responded favorably to the CAP

implementation. Once begun, the community partners expressed interest to sustain the

partnership. Continual study is recommended through the completion of the MSN CNL

internship, the subsequent two semesters, to determine the benefit to master’s nursing education

and the community agencies.

A graduate level nursing CAP caring for community-dwelling older adults is critically

needed in academia beyond one semester. Nursing academia can be the leaders in preparing

MSN students to respond to the health needs of the growing older adult population through

CAPs established between academic institutions and organizations serving community-dwelling

older adults. It is paramount that MSN nursing students are prepared to respond to the

population health needs of the community-dwelling older adult to assist them to age in place

through the promotion of independence and healthier living.


Section V1. Funding

No funding was awarded for the development, implementation, and evaluation of the

Gerontological CAP project, and to write the DNP comprehensive paper. The costs of this

program were embedded in the faculty cost to teach the CNL course and the persons employed

by the participating community organizations.


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Table 1

Facts on Aging Quiz, Baseline (Pre-Semester) Results

Ques

#

TRUE

(T)

FALSE

(F) betw/

no

Mark N

True

%

False

%

Correct

Ans.

Total

T&F

Answered

Correct

%

1 7 7 0 100% F 100% 100

2 6 1 7 0% 86% F 86% 86

3 1 6 7 14% 86% F 100% 86

4 4 3 7 57% 43% F 100% 43

5 2 5 7 29% 71% T 100% 29

6 2 5 7 29% 71% T 100% 29

7 2 4 1 7 29% 57% F 86% 57

8 6 1 7 86% 14% T 100% 86

9 7 7 0% 100% F 100% 100

10 5 2 7 71% 29% T 100% 71

11 5 2 7 71% 29% F 100% 29

12 4 2 1 7 57% 29% T,F 86% 100

13 4 3 7 57% 43% T 100% 57

14 7 7 0% 100% F 100% 100

15 6 1 7 86% 0% T 86% 86

16 6 1 7 86% 14% T 100% 86

17 6 1 7 0% 86% F 86% 86

18 4 3 7 57% 43% T 100% 57

19 7 7 0% 100% F 100% 100

20 5 2 7 71% 29% F 100% 29

21 3 4 7 43% 57% T 100% 43

22 4 3 7 57% 43% T 100% 57

23 6 1 7 0% 86% F 86% 86

24 1 6 7 14% 86% T 100% 14

25 3 4 7 43% 57% F 100% 57

26 3 4 7 43% 57% F 100% 57

27 3 4 7 43% 57% F 100% 57

28 7 7 0% 100% F 100% 100

29 1 6 7 14% 86% T 100% 14

30 1 6 7 14% 86% T 100% 14

31 7 7 0% 100% F 100% 100

32 4 3 7 57% 43% T 100% 57

33 1 5 1 7 14% 71% F 86% 71

34 2 5 7 29% 71% F 100% 71

35 1 6 7 14% 86% F 100% 86


36 7 7 0% 100% F 100% 100

37 2 5 7 29% 71% F 100% 71

38 2 4 1 7 29% 57% T 86% 29

39 2 5 7 29% 71% F 100% 71

40 4 3 7 57% 43% F 100% 43

41 7 7 0% 100% F 100% 100

42 7 7 0% 100% F 100% 100

43 7 7 100% 0% T 100% 100

44 3 3 1 7 43% 43% F 86% 43

45 1 6 7 14% 86% F 100% 86

46 7 7 0% 100% F 100% 100

47 7 7 100% 0% T 100% 100

48 2 4 1 7 29% 57% T 86% 29

49 7 7 100% 0% T 100% 100

50 1 6 7 14% 86% F 100% 86

Total

T&F 3459

Mean 69.18

Median 71

Mode 100


Table 2

Facts on Aging Quiz, Post-Semester Results

Ques

#

True

(T)

False

(F) betw/

no

Mark N True % False %

Correct

Ans.

Total

T&F

Answered

Correct

%

1 6 1 7 0.00 0.86 F 0.86 86

2 7 7 0.00 1.00 F 1.00 100

3 6 1 7 0.00 0.86 F 0.86 86

4 3 4 7 0.43 0.57 F 1.00 57

5 2 3 2 7 0.29 0.43 T 0.71 29

6 4 3 7 0.57 0.43 T 1.00 57

7 1 6 7 0.14 0.86 F 1.00 86

8 4 2 1 7 0.57 0.29 T 0.86 57

9 1 6 7 0.14 0.86 F 1.00 86

10 4 2 1 7 0.57 0.29 T 0.86 57

11 2 5 7 0.29 0.71 F 1.00 71

12 3 1 1 2 7 0.43 0.14 T,F 0.57 100

13 4 3 7 0.57 0.43 T 1.00 57

14 7 7 0.00 1.00 F 1.00 100

15 7 7 1.00 0.00 T 1.00 100

16 6 1 7 0.86 0.00 T 0.86 86

17 5 2 7 0.00 0.71 F 0.71 71

18 5 2 7 0.71 0.29 T 1.00 71

19 1 5 1 7 0.14 0.71 F 0.86 71

20 3 4 7 0.43 0.57 F 1.00 57

21 4 3 7 0.57 0.43 T 1.00 57

22 2 4 1 7 0.29 0.57 T 0.86 29

23 1 4 2 7 0.14 0.57 F 0.71 57

24 2 5 7 0.29 0.71 T 1.00 29

25 2 5 7 0.29 0.71 F 1.00 71

26 7 7 0.00 1.00 F 1.00 100

27 4 3 7 0.57 0.43 F 1.00 43

28 1 6 7 0.14 0.86 F 1.00 86

29 2 5 7 0.29 0.71 T 1.00 29

30 2 5 7 0.29 0.71 T 1.00 29

31 1 6 7 0.14 0.86 F 1.00 86

32 5 2 7 0.71 0.29 T 1.00 71

33 1 6 7 0.14 0.86 F 1.00 86

34 7 7 0.00 1.00 F 1.00 100

35 1 6 7 0.14 0.86 F 1.00 86

36 7 7 0.00 1.00 F 1.00 100

37 1 6 7 0.14 0.86 F 1.00 86


38 3 4 7 0.43 0.57 T 1.00 43

39 1 6 7 0.14 0.86 F 1.00 86

40 2 5 7 0.29 0.71 F 1.00 71

41 7 7 0.00 1.00 F 1.00 100

42 6 1 7 0.00 0.86 F 0.86 86

43 7 7 1.00 0.00 T 1.00 100

44 2 4 1 7 0.29 0.57 F 0.86 57

45 2 5 7 0.29 0.71 F 1.00 71

46 7 7 0.00 1.00 F 1.00 100

47 7 7 1.00 0.00 T 1.00 100

48 5 2 7 0.71 0.29 T 1.00 77

49 7 7 1.00 0.00 T 1.00 100

50 1 6 7 0.14 0.86 F 1.00 86

Total T&F/Class 3707

Mean 74.14

Median 81.5

Mode 86


Table 3

Aging Semantic Differential Tool, Baseline (Pre-Semester) Results

Adjective 1 2 3 3.5 4 5 6 7 Adjective N

Progressive 1 2 2 1 1 Old-fashioned 7

Consistent 2 3 1 1 Inconsistent 7

Independent 2 2 1 2 Dependent 7

Rich 1 1 3 2 Poor 7

Generous 1 4 1 1 Selfish 7

Productive 3 1 1 1 1 Unproductive 7

Busy 1 2 1 1 1 1 Idle 7

Secure 1 2 1 2 1 Insecure 7

Strong 2 1 1 1 2 weak 7

Healthy 1 2 1 2 1 Unhealthy 7

Active 1 2 1 3 Passive 7

Handsome 1 1 1 3 1 Ugly 7

Cooperative 3 1 1 2 Uncooperative 7

Optimistic 1 1 2 1 2 Pessimistic 7

Satisfied 2 2 1 1 1 Dissatisfied 7

Expectant 1 2 1 1 2 Resigned 7

Flexible 1 1 1 3 1 Inflexible 7

Hopeful 2 1 1 2 1 Dejected 7

Organized 1 4 1 1 Disorganized 7

Happy 2 3 1 1 Sad 7

Friendly 5 1 1 Unfriendly 7

Neat 2 3 1 1 Untidy 7

Trustful 1 3 1 1 1 Suspicious 7

Self-reliant 2 2 1 1 1 Dependent 7

Liberal 1 1 3 2 Conservative 7

Certain 4 1 1 1 Uncertain 7

Tolerant 1 2 1 2 1 Intolerant 7

Pleasant 1 2 2 1 1 Unpleasant 7

Ordinary 1 2 1 2 1 Eccentric 7

Aggressive 1 4 2 Defensive 7

Exciting 3 1 1 2 Dull 7

Decisive 4 1 1 1 Indecisive 7

Total 6 52 53 32 53 21 6 1 224

6 104 159 112 212 105 36 7 735

Average/student 105

Best possible score/student 32


Table 4

Aging Semantic Differential Tool, Post-Semester) Results

Adjective 1 2 3 3.5 4 5 6 7 Adjective N

Progressive 1 1 2 3 Old-fashioned 7

Consistent 3 1 3 Inconsistent 7

Independent 2 1 3 1 Dependent 7

Rich 3 2 2 Poor 7

Generous 3 2 2 Selfish 7

Productive 3 3 1 Unproductive 7

Busy 1 3 3 Idle 7

Secure 3 2 2 Insecure 7

Strong 1 3 2 1 weak 7

Healthy 4 2 1 Unhealthy 7

Active 3 1 2 1 Passive 7

Handsome 1 3 3 Ugly 7

Cooperative 2 2 2 1 Uncooperative 7

Optimistic 3 2 1 1 Pessimistic 7

Satisfied 2 3 2 Dissatisfied 7

Expectant 4 3 Resigned 7

Flexible 1 4 2 Inflexible 7

Hopeful 1 5 1 Dejected 7

Organized 2 3 2 Disorganized 7

Happy 4 2 1 Sad 7

Friendly 6 1 Unfriendly 7

Neat 3 2 2 Untidy 7

Trustful 4 2 1 Suspicious 7

Self-reliant 2 4 1 Dependent 7

Liberal 1 3 2 1 Conservative 7

Certain 1 4 2 Uncertain 7

Tolerant 5 2 Intolerant 7

Pleasant 3 3 1 Unpleasant 7

Ordinary 1 5 1 Eccentric 7

Aggressive 3 3 1 Defensive 7

Exciting 2 1 3 1 Dull 7

Decisive 3 2 2 Indecisive 7

Total 1 58 74 0 70 19 1 1 224

1 116 222 0 280 95 6 7 726

103.7

Best possible score/student 32

Average score/student


Table 5

Responses to Student Reflection Questions

N=7

1. What opportunities have you had to contribute to the microsystem?

• Bring a new, different perspective

• Interactions with clients

• Solicitation of clients’ needs

• Gathering data

• Organizing materials

• Create data collection tools

• Research

• Sharing perceptions

2. What new insights have you gained from the service-learning practicum?

• Observe how a non-profit works

• How to meet patient and family multiple needs at a vulnerable time (hospice)

• The huge demand and need for older adults to stay active and engaged

• Need to help older adults stay autonomous, healthy, and social

• Existence of many layers and obstacles to implement change

• Takes time to make system change

• Change takes collaboration and patience

• System vs. patient care perspective

3. What new knowledge/skills have you learned from working with an interdisciplinary

team?

• Communication within an interdisciplinary team

• Coordination of patient care

• Roles of social workers and how they support their clients and connect them to

community services

• Difficulty to manage medically complex hospice clients and keep them safely in

the community and in their homes without medical support staff

• Working interdependently towards a common objective

• Bringing together threads of information or progress

• Resistance to change

• Active listening

• Role of nurse manager


4. What new knowledge have you gained regarding community or microsystem resources

that address social or population health problems?

• Comfort vs. curative care in hospice

• End-of-life care requires an abundance of resources and collective effort

• Community social services, i.e., food bank connects older adults with healthy

food; meals on wheels is a saving grace for many homebound adults in the

community; mobility services, economic assistance, and medical care

• Capable, caring, like-minded people in the community who are working towards

solutions to complex problems

• Veteran services

• Home wound care for post-op patients


Table 6

Community Agency Survey Results (n=4)

Survey Questions Strongly

Agree Agree Disagree Strongly

Disagree N/A

Collaborative experience of formulating goals together for the community-academic partnership with USF SONHP

100%

Ongoing collaboration and coordination occurred with USF SONHP

100%

Student’s role and rationale for placement was shared with the community agency

75% 25%

If an issue or conflict arose, response from the assigned faculty was timely

50% 50%

If an issue or conflict arose, faculty’s response was appropriate to the situation/issue

25% 25% 50%

If a problem or conflict arose, faculty or students worked collaboratively to address the issue with you

25% 25% 50%

Student demonstrated consistent initiative

75% 25%

Student was consistently dependable

50% 50%

Student’s collegiality with staff and clients was appropriate to the situation/work environment

100%

Please indicate benefits to your agency due to this CAP: Identifying needs to better serve clients


Appendix A

DNP Statement of Non-Research Determination Form

Student Name:___Francine Serafin-Dickson_____________

Title of Project: Community-Academic Partnership Gerontological Nursing Internship

Brief Description of Project:

A) Aim Statement:

By September 2017, develop, implement, and evaluate community-academic

partnerships, incorporating service-learning pedagogy, for a gerontological community-

based nursing internship to meet the growing population health needs of community-

dwelling older adults and expand learning and workforce opportunities

for University of San Francisco MSN CNL graduates.

B) Description of Intervention:

Create a community-based gerontological nursing internship through structured

community-academic partnerships (CAPs).

C) How will this intervention change practice?

MSN CNL graduates will have enhanced attitudes re: older adults and increased

knowledge of the community-dwelling older adults’ social determinants of health.

Faculty will develop new knowledge re: community-based agency placement.

Gerontological curriculum for community-based older adults will be available to be used

in interprofessional schools within SONHP.

Future nursing workforce will be prepared to lead the coordination of care for

community-dwelling older adults, which will enable the older adult population to age in

place.

D) Outcome measurements:

o Number of CAPs established

o Types of community settings

o Number of students immersed in CAP internship

o Community partner: quality and timeliness of communication; mutual goal

setting; mutual identification of student(s) QI project; benefit to community

organization.

o Students’ pre- and post-attitudes re: older adults

o Students’ pre- and post-knowledge re: community-dwelling older adults’ needs

o Number of student interactions with older adults and type of community setting

To qualify as an Evidence-based Change in Practice Project, rather than a Research Project, the

criteria outlined in federal guidelines will be used:


(http://answers.hhs.gov/ohrp/categories/1569)

☐ xThis project meets the guidelines for an Evidence-based Change in Practice Project as

outlined in the Project Checklist (attached). Student may proceed with implementation.

☐This project involves research with human subjects and must be submitted for IRB approval

before project activity can commence.

Comments:

EVIDENCE-BASED CHANGE OF PRACTICE PROJECT CHECKLIST *

Instructions: Answer YES or NO to each of the following statements:

Project Title:

YES NO

The aim of the project is to improve the process or delivery of care with

established/ accepted standards, or to implement evidence-based change. There is

no intention of using the data for research purposes.

x

The specific aim is to improve performance on a specific service or program and is

a part of usual care. ALL participants will receive standard of care.

x

The project is NOT designed to follow a research design, e.g., hypothesis testing

or group comparison, randomization, control groups, prospective comparison

groups, cross-sectional, case control). The project does NOT follow a protocol that

overrides clinical decision-making.

x

The project involves implementation of established and tested quality standards

and/or systematic monitoring, assessment or evaluation of the organization to

ensure that existing quality standards are being met. The project does NOT

develop paradigms or untested methods or new untested standards.

x

The project involves implementation of care practices and interventions that are

consensus-based or evidence-based. The project does NOT seek to test an

intervention that is beyond current science and experience.

x

The project is conducted by staff where the project will take place and involves

staff who are working at an agency that has an agreement with USF SONHP.

x

The project has NO funding from federal agencies or research-focused

organizations and is not receiving funding for implementation research.

x

The agency or clinical practice unit agrees that this is a project that will be

implemented to improve the process or delivery of care, i.e., not a personal

research project that is dependent upon the voluntary participation of colleagues,

students and/ or patients.

x

If there is an intent to, or possibility of publishing your work, you and supervising

faculty and the agency oversight committee are comfortable with the following

statement in your methods section: “This project was undertaken as an Evidence-

based change of practice project at X hospital or agency and as such was not

formally supervised by the Institutional Review Board.”

x

http://answers.hhs.gov/ohrp/categories/1569



Appendix B1




Appendix B2




Appendix C

Evaluation Table of the Literature

John Hopkins Research Evidence Appraisal Tool (JHREAT) John Hopkins Non-Research Evidence Appraisal Tool (JHNREAT) Independent variables (IV): Dependent Variables (DV) Intervention group (IG); Control group (CG)

Citation Conceptual Framework

Design/ Method

Sample/ Setting

Variables Studied &

Definitions

Measurement

Data Analysis Findings Appraisal: Worth to Practice

Beauvais et al. (2015). Service learning with a geriatric population.

Geronto-logical SL as pedagogy in nursing.

Quantitative study that examined undergraduate nursing students’ attitudes and knowledge about the elderly, before and after an experience with older adults. Identified steps to establish a CAP: (1) develop partnership(s), (2) coordinate

134 nursing sophomore students in a health assessment class. IG: 66 students participated in 12 hrs. of SL at a Senior Citizen Center doing interviewing, teaching, health assessments, and making observations;

IVs: students experience and previous experience with older adults. DVs: attitude and knowledge toward older adults.

Kogan’s Attitudes Toward Old People Scale was used to measure attitudes: higher scores reflect a positive attitude, and conversely, lower scores reflect a more negative

Used SPSS: t-test was used to evaluate between the two groups at a .05 level of significance for both measurement tools.

Attitudes toward older adults: IG increased and negative attitudes decreased; CG did not change from baseline. Knowledge about older adults: IG significantly improved; CG did not change from baseline.

IG and CG; used reliable and valid tools; good literature review. Applicable to further Gerontolo-gical SL experiences for students due to proven value in this one experiment. CAP steps: (1)

establish


schedules, (3) set goals for students and the community agency, (4) implement plans, and (5) develop evaluation metrics.

documenting reflections. CG: 68 students spent 12 hrs. in an LTC facility, administer-ing medications & perform- ing AM care.

attitude toward older adults. Palmore’s Fact on Aging Quiz was used to measure knowledge about older adults.

partnership

(s); (2)

coordinate

schedules;

(3) set

students

and

partnership

goals;

(4)

implement

plans; and

(5) develop

evaluation

metrics. JHREAT: IIB.

Butterfoss, F.D. (2009). Evaluating partnerships to prevent and manage chronic disease.

Program Evaluation in Public Health in relationship to partnerships

Guidelines for applying partnership evaluation: (1) engage stakeholders, (2) describe the partnership, (3) focus on evaluation design, (4) gather credible evidence, (5) justify

Public-private partners

N/A Recommended evaluation criteria: access to essential health and human services (e.g., housing, nutrit-ion); morbidi-

N/A

Provided evaluation criteria and measures: partnership perceptions, satisfaction with group functioning, clarity of partnership mission, goals; joint planning of activities; sense of ownership; mutual support;

Recommended criteria to measure value to sustain partnership. JHNREAT:VB


conclusions, (6) ensure use and share lessons learned.

ty & mortali-ty stats.

collective problem solving; coordination

effectiveness;

conflict

management;

efficacy in

managing

partnership

process; quality

and frequency of

interactions;

relationships; &

staff performance.

Clemmens et al. (2009). Geriatric nursing education in community health: CareLink--partnering for excellence.

Community health knowledge and skill building for older adults.

Quasi-

experiment,

descriptive. Partnership

requirements:

knowledge of

the

community,

open

communication

, and a culture

of caring.

115 senior

baccalaureate

student

nurses;

community

health

experience in

congregate

care site

within a

naturally

occurring

retirement

community

(NORC)

IV: 14-week semester immersed in a weekly community clinical experience and twice weekly didactic classes. DVs: Skills in using nursing process to care for older adults, cultural

Public

Health

Nurse

Inventory

(PHNI)

instrume

nt;

Cultural

Compete

nce

Scale;

Index of

Disciplin

ary

Collabora

tion;

Student

Focus

PHNI:

statistically

significant

improvement

in

competencies

(p<0.001).

Cultural

Competence

scale showed

an increase in

students’

cultural

competence at

(p<.05).

The PHNI

showed improve-

ment in applying

the nursing

process to

individuals,

families, &

communities &

incorporating

public health and

cultural

competencies.

Cultural

Competence

increased in Index

of Disciplinary

Collaboration

results were not

Used reliable and valid tools to measure community health competencies needed to work with community-dwelling older adults. JHREAT: IIB.


competence, and interdisciplinary collaboration.

Groups;

Reminisc

ence

therapy/r

eflections

.

available at

publication.

Focus groups

indicated an

increase in

knowledge &

skills in working

w/

interdisciplinary

teams, which

improved their

older adult

clients’ outcomes.

Reflections

demonstrate

relationship

building with

their clients.

Drahota et al.

(2016).

Community-

academic

partnerships:

A systematic

review of the

state of the

literature and

recommendat

ions for

future

research.

Community-academic partnership (CAP).

Systematic

search of 6

major lit

databases

generating

1332 articles,

50 met

inclusion

criteria

Lit review of

community-

academic

research

partnerships.

IV: area of study; initiation, types of partners, funding, # of partners, duration of CAPs. DV: Interper-sonal and operational factors to facilitate or

Lit

review of

IVs; % of

facilita-

ting and

hindering

factors.

Analyzed

studies to

describe CAP

characteristics

, identify

terms &

methods used,

and common

influences of

CAP

processes and

outcomes.

72% desire a tangible product from CAP. Facilitating factors: (a) trust; (b) respect; (c) shared vision, mission and/or goals; (d) good relationships; (e) effective and/or frequent communication; (f) well-structured

Common influences that facilitate and hinder CAPs that guide development and sustain-ment. JHREAT: IIIA.


hinder collabora-tive processes of CAPs.

meetings; (g) clear roles/functions; (h) leadership; (i) effective conflict resolution; (j) good selection of partners; (k) community impact; and (l) mutual benefit. Hindering factors: (a) excessive time commitment; (b) unclear roles/functions; (c) poor communication; (d) inconsistent participation; (e) burdensome tasks; (f) lack of shared vision, mission, goals; (g) differing expectations; (h) mistrust; (i) lack of common or shared language; and (j) bad relations.


Ezeonwu et

al. (2013). Using an academic-community partnership model and blended learning to advance community health nursing pedagogy.

Community-as-Partner Model

Online

pedagogical

approach to

teach

community

health

undergrad

nurses in the

community.

Immigrants

in Seattle,

Washington;

40

community

participants

ID: Student reflection questions: Positive and negative aspects of experience; strategies to change or modify process. DV: communica-tion betw/ academia & community partner; integrating classroom content into community experience benefited students and faculty; promotes creativity in solving community health problems; and involves student in

Student

reflec-

tions.

Evaluation of

student reflec-

tions.

Benefitted academia and community partners; students became strong advocates for public health policy and programs directed to underserved, Promoted problem-centered approach to learning; reality vs. theory learning; stronger synthesis of in and out of class

Online commun-ity health focused class; good reflective questions. JHNREAT: VB


own learning.

Kruger et

al., (2010).

Engaging

nursing

students in a

long-term

relationship

with a

home-base

community.

Study model

was

conceptual yet

was based on

a theoretical

framework of

service-

learning and

nursing

pedagogy.

Qualitative

study of 4

cohorts of

students over

four years.

A survey and

focus groups

were

conducted of

nursing

students at

entry,

midpoint, and

at the end of

the program.

CAP

essentials:

immerse

faculty

&students in

community,

increase

capacity of

community

initiatives,

work w/

partner to

address

community

issues, and

engage in

190

responses

were

reported in

an exit

survey for

two

graduating

classes.

The students

were queried

on clinical

objectives,

community

work, and

learning

outcomes of

community

health

nursing

practicum.

Survey

tool.

Preliminary

survey

outcomes are

consistent

with findings

in national

studies of

service-

learning.

(Kruger et al,

2010)

2006 graduating

seniors (n=97,

71% response

rated)

consistently

indicated they

could ‘see the big

picture’ (88%),

“make a

difference” in the

health of their

community

(78%), gain an

appreciation for

the health

promotion role of

the nurse (85%),

and shed

underlying

prejudices (80%).

NCLEX pass

rates above/equal

with national

averages.

CAP: reported

longitudinal

clinical

experience

improved

students’ gero

competencies.

CAP

adequately

explained

along with

nursing

program

logistics.

JHREAT: IIIB.


continuously to

build

sustainability.

Trail Ross, M. E. (2012). Linking classroom learning to the community through service learning.

SL Evaluation of

SL and value

to community

partner

76 junior

BSN

students

working 8

hrs. in a

community-

based adult

day center in

combination

w/ a

gerontology

course.

IV: students’

and

community

agency

evaluation

components

DV: SL

benefit.

Community partner questions: Community agency activities for clients? Community agency type of staff and their role? Assistance provided by student? Student’s observant-ions of older adults’ health status, needs and concerns?

Qualitati

ve

questionn

aires for

students

and

communi

ty

agencies.

Evaluation

questions

rated on

excellent,

good and fair

or strongly

agree, agree

or disagree,

measure with

% of

agreement by

evaluators.

Students’

feedback was

very positive in

regards f

supplication of

class content,

overcoming bias

and

understanding of

gero pop,

understanding

role of caregivers.

Community

agency feedback

was very positive:

increasing

capacity of

community

agency, students’’

sensitivity and

reliability.

Student and community agency evaluation tools. JHREAT: IIIB.


Community eval: students’ perfor-mance, effort, and attitude.

Voss et al., (2015). Community-academic partnerships: Developing a service-learning framework.

Service-

learning

framework

used within

CAPs.

Development

and

measurement

of SL

framework.

Undergrad

nursing

students in

CAPs.

IV: CAP

outcomes,

students’

community

projects,

student

reflections,

client

outcomes,

DV: SL

benefit.

Student

reflection

questions: What is working well this week? What barriers did you face this week? What challenges did you face this week? If you had to

do it again,

Quality

improve-

ment:

QOL,

health

literacy,

access to

resources

, &

perceptio

n of

overall

health.

Quant

measures

: BP, ED

visits,

adherenc

e to

wellness

plans.

Student

reflection

questions

.

Community

partner

brainstorming

; content

analysis;

faculty

perspective;

students’

perspective of

benefits of

SL; students’

projects.

Feasibility:

Create timeline

for data collection

& analysis.

Access: need to

establish

infrastructure of

CAP.

Analysis: see data

analysis.

Multiple

evaluation

metrics and

key

elements to

set up SL

within a

CAP: (1)

create

project

outline and

timelines;

(2) develop

mutual and

measurable

outcomes;

(3) manage

data:

identify

baseline

and future

metrics and

tools; (4)

clarify

expectation

s; and (5)


what would

you do

differently?

What would

you do the

same?

navigate

students

through the

community

agency.

JHREAT: IIIA.


Appendix D

Letter of Support from Academic Partner


Appendix E

Improvement Project Roadmap

Institute for Healthcare Improvement

1. Set an Aim: What are you trying to accomplish?

2. Develop an improvement strategy

3. Develop and pilot a reliable standard process of care

4. Implement the standard of care process and monitor performance

5. Spread the new standard through the system

(IHI, 2017)


Appendix F1

Gerontological Community-Academic Partnership Agency Placement Options

Agency Venue Location

Hospice and Home Health Home Health San Mateo

Hospice San Mateo

Palliative Care San Mateo

Hospice and Home Health Home Health So. San Francisco, Mountain View, Oakland

Hospice So. San Francisco, Mountain View, Oakland

Social Support Service Care Transitions San Mateo

Sr. Peer Counseling San Mateo

Sequoia 70 San Mateo

Fair Oaks Activity Center Redwood City

Nutritional Support Service Nutritional Assessments & Meal Delivery Menlo Park; San Mateo County

Friendly visitor San Mateo County

Fall Prevention in home San Mateo County

Social Support Service Senior Services San Francisco

Adult Day Care Center San Francisco

Home assessments San Francisco

Case management San Francisco

Villages Village member home needs assessments San Carlos, Redwood City, San Mateo

Voluntary Health Dementia Capable Supports and Services initiative San Francisco

Support to clients & caregivers San Francisco

Med reconciliation San Francisco Provider education San Francisco


Appendix F2

Gerontological (Gero) Curriculum for Community-Based MSN CNL Internship:

Community-Academic Partnership (CAP) FOR 4+1 BSN-MSN STUDENTS

Francine Serafin-Dickson

University of San Francisco

School of Nursing and Health Professions

I. Goals of Internship

o To apply the concept of holistic and person-centered care in interactions with older

adults.

o To understand the burdens, benefits, and struggles of aging.

o To have a knowledge of the community-dwelling older adults’ social determinants of

health and functional needs to assist older adults to age in place.

o To improve awareness of community resources to assist older adults to sustain and/or

improve their current health status.

o To improve decision-making and care coordination skills to improve quality of life

for community dwelling older adults.

II. Course Description

This integrated course for the MSN CNL role courses and hours offers a service- learning

experience within community agencies serving community-dwelling older adults. The

purpose of the course will result in enhancement of students’ knowledge (essential

knowledge domains) and skill application (essential nursing actions) regarding older

adults’ health needs while also developing an understanding of the social determinants of

and community resources for this population. The practicum will assess and respond to

the social determinants of the burgeoning older adult (> 65 years) population to assist the

them to age in place. Students will apply the knowledge of health and wellness

promotion, disease prevention, and aging to promote independence in the community-

dwelling older adult population. The National League of Nursing (NLN) ACES

framework will guide the curriculum: (1) the learning environment (the community), (2)

essential nursing actions, and (3) essential knowledge domains. The essential knowledge

domains are individualized aging, complexity of care, and vulnerabilities during life

transitions. The essential nursing actions include the following: Assess function and

expectations; Coordinate and manage care; use of Evolving knowledge; and make

Situational decisions.

Course instruction will be based on the concept of person-centered care where the

community-dwelling older adult’s values and preferences will guide their health care

decisions and goals. The CNL student will apply the roles of advocate; educator; systems

analyst/risk anticipator; information, outcomes and team manager. In the final stage of

this internship, students will demonstrate their skills as a change agent and apply

evidence-based practice into a health improvement project for the community partner.


Students will leave the course with an expanded knowledge and skills needed to

interface, assess, and coordinate care for the community-dwelling older adult population.

III. Course Objectives

➢ Understand and apply concepts of the biological process of aging, prevention, health

promotion, epidemiology, and coordination of care as it relates to the community-

dwelling older adult.

➢ Evaluate social services and levels of care, including acute, community-based, and

long-term care (e.g., home care, home health care, assisted living, hospice, nursing

homes) for older adults and their families, and how these services intersect with

public policy.

➢ Assist older adults and families/caregivers to access knowledge and evaluate

resources to remain active contributors to society (NLN ACES, 2011). Coordinate

connection and/or use of community resources through referral or community service

navigation to promote functional, physical, and psychosocial wellness in older adults.

➢ Access and use emerging information and research evidence regarding the special

care needs of older adults (NLN ACES, 2011).

➢ Assess the community environmental resources, barriers, and policies as it relates to

functional, physical, cognitive, psychological, and social needs of older adults.

➢ Apply respectful communication and relationship management skills to create an

environment that recognizes and values differences in the older adult, family,

caregiver, and interdisciplinary team.

➢ Observe and understand the ethical decision-making for older adults and/or

families/caregivers regarding care/treatment approaches and end-of-life decisions

based on the older adult’s wishes, expectations, resources, lived experiences, culture,

and strengths.

➢ Partner with the community organization to implement a quality improvement

approach to address clients’ needs or to improve community capacity to meet social

service and care coordination needs of community-dwelling older adults.

IV. Required Readings: See teaching resources, suggested readings, and other postings

applicable to curriculum content.

V. Pedagogy

➢ Service-learning theoretical framework within a Community-Academic Partnership

➢ CNL role course hours within a community-based agency serving community-

dwelling older adults

➢ Integrated didactic seminar

➢ Faculty interactions

➢ Agency mentor/preceptorship

➢ Reflections

➢ Evaluations

VI. Evaluation Tools

➢ Community-Academic Partnership: number and type

➢ Community partner evaluation

➢ Student Reflections


➢ CNL Course evaluations: student and preceptor

➢ Student knowledge, skills, and attitudes pre- and post-course:

1. Palmore Fact on Aging Quiz aka FAQ

2. Aging Semantic Differential Tool

VII. Course Content

o Orientation to community partner(s)

o Overview and assessment of community agency partnerships and assessment

o Social determinants of health: social, behavioral, environmental, ecological, economic,

cultural

o Human development and aging

➢ Functional assessment skills

➢ Self-rated assessment of health status

➢ Functional status: independent to frail; ADLs

➢ Self-care/self-management model/health behaviors

➢ Skin

➢ Hygiene & house upkeep

➢ Sight & hearing

➢ Cognitive status

➢ Medication management/polypharmacy

➢ Access to health care

➢ Recent hospitalizations and physician visits

➢ Chronic and degenerative disease; co-morbidities

➢ Disability coping and strength building

➢ Pain management

➢ Sleep problems

➢ Exercise & Activity

➢ Screenings: Blood pressure, depression, falls, home safety, sleep, chronic disease, etc.

o Nutrition

➢ Appetite

➢ Food security

➢ Food prep

➢ Oral care & hygiene

➢ Hydration Mental/behavioral health

➢ Affect

➢ Satisfaction with life

➢ Emotional well-being

➢ Anxiety

➢ Depression

➢ Coping skills to adjust to change

➢ Dementia

➢ Alzheimer’s

➢ Coping skills

➢ Gero-psych resources

o Social health

➢ Demographic data


➢ Beliefs

➢ Spiritual dimension; religion

➢ Cultural dimension

➢ Economic/financial

➢ Homebound/isolated or independent

➢ Purposeful living: Work/volunteerism/civic participation

➢ Family structure & support; influence on family dynamics

➢ Relationships

➢ Neighborhood

➢ Safety

➢ Living situation; housing security

➢ Loss/Grief/bereavement

➢ Freedom/control over life

➢ Transportation

➢ Leisure/activities

➢ Support systems

➢ Sexual Orientation

o Fall prevention evidence-based practices

➢ Medication management/polypharmacy; Beers criteria

➢ Home Safety

➢ Exercise/balance/strength

➢ Vision & hearing annual checks

o CDC Stopping Elderly Accidents & Deaths

➢ Transitional Care

➢ Transitions of Care programs: Coleman and Naylor (TCM)

➢ Hospital assessments at discharge

➢ Home assessment on discharged pts.

➢ Health Coaches

o Community levels of care

➢ Home Health

➢ Home care

➢ Assisted Living/RCFE/Board & Care

➢ Skilled Nursing Facilities

➢ Senior Housing

➢ Rehab

➢ Sub-acute

➢ Respite

o Community and population level needs assessment: programs, policies, resources/assets, and

barriers

➢ Transportation

➢ Housing

➢ Public health services

➢ Community-based adult day services

➢ Exercise classes

➢ Meals on Wheels

➢ Agency Area on Aging: Area Plan Goals


➢ Commission on Aging

➢ Senior Centers

➢ Geriatric Clinics

➢ Villages

➢ Faith-based organizations

➢ Health education/promotion/screenings: falls, HTN, depression

➢ Adult Protective Services/Elder Abuse

➢ LGBT

➢ Alzheimer’s Association

➢ Caregiver Alliance

➢ Suicide prevention: Friendship Line

➢ Healthcare and social programs: Medicare, Medicaid, Veterans, Social Security,

Older Americans Act

➢ Local Community Resources

▪ HART Program, Daly City

▪ Sequoia Strong: Peninsula Family Service & Sequoia Healthcare District

▪ Self-Help for the Elderly (San Mateo and San Francisco)

▪ Villages x3 (San Francisco)

▪ Villages x5 (San Mateo County)

o End-of-Life care/advance care planning

➢ Advance Care Planning

➢ Ethical-legal issues

➢ Palliative Care

➢ Hospice

➢ Advance Health Care Directive [AHCD]

➢ Physician Orders for Life Sustaining Treatments

➢ Five Wishes

➢ Coalition for Compassionate Care of California

➢ Listening and presence skills

➢ Cultural and spiritual assessment

➢ Pharmacologic management of pain and symptoms

o Communication

➢ Listening

➢ Teamwork/develop relationship with the community and across the continuum of care

➢ Motivational interviewing skills

➢ Inter-professional collaboration of care

➢ Sensory deficits

➢ Cultural preferences

o Caregiving

VIII. Teaching Resources

➢ AARP (American Association of Retired Persons) http://www.aarp.org/

➢ Administration on Community Living http://www.aoa.gov/

➢ Administration on Community Living Profiles of Older Americans

https://aoa.acl.gov/Aging_Statistics/Profile/index.aspxAmerican Society on Aging

http://www.asaging.org/

http://www.aarp.org/

http://www.aoa.gov/

http://www.asaging.org/


➢ Aging https://www.youtube.com/watch?v=oeVfV8yOg_I

➢ Association for Gerontology in Higher Education

https://www.aghe.org/images/aghe/competencies/gerontology_competencies.pdf

➢ California Dept. of Aging Programs & Services https://www.aging.ca.gov/Programs/

➢ Center for Disease Control Healthy Aging https://www.cdc.gov/aging/index.html

➢ Center for Disease Control STEADI https://www.cdc.gov/steadi/index.html

➢ Connected Care: Chronic Care Management https://www.cms.gov/About-CMS/Agency-

Information/OMH/equity-initiatives/chronic-care-management.html

➢ ConsultGeri-clinical website for HIGN https://consultgeri.org/

➢ Culture Change A national movement re: the transformation of older adult services,

based on person-directed values and practices where the voices of elders and those

working with them are considered and respected.

http://www.pioneernetwork.net/CultureChange/

➢ End-of-Life Nursing Education Consortium (ELNEC) http://www.aacn.nche.edu/elnec

➢ Frameworks Institute. (2017). Gaining momentum: A quick start guide. Gaining

Momentum: A Frameworks Communication Toolkit. Washington, D.C. Retrieved from

http://frameworksinstitute.org/toolkits/aging/elements/items/aging_bp_quickstart.pdf

➢ Growing Old in a New Age: Myths and Truths of Aging

https://www.google.com/search?q=Growing+Old+in+a+new+Age-

Truths+%26+Myths+of&rlz=1C1DIMA_enUS687US687&oq=Growing+Old+in+a+new

+Age-

Truths+%26+Myths+of&aqs=chrome..69i57.149977j0j4&sourceid=chrome&ie=UTF-8

➢ Hartford Institute for Geriatric Nursing https://hign.org/

➢ Healthy People 2020 https://www.healthypeople.gov/2020/topics-objectives/topic/older-

adults

➢ Milken Institute Center for the Future of Aging

http://www.milkeninstitute.org/centers/the-center-for-the-future-of-aging

➢ National Council on Aging https://www.ncoa.org/

➢ NIH Senior Health http://nihseniorhealth.gov/

➢ Nurses Improving Care for Heath System Leaders http://www.nicheprogram.org/

➢ National Research Center [NRC]. (n.d.) Community assessment survey for older adults.

Retrieved from http://www.n-r-c.com/survey-products/community-assessment-survey-

for-older-adults/

➢ PACE (Program of All-inclusive Care for the Elderly): A Medicare and Medicaid

program that helps people meet their health care needs in the community instead of going

to a nursing home or other care facility. https://www.medicare.gov/your-medicare-

costs/help-paying-costs/pace/pace.html

➢ Recommended Baccalaureate Competencies and Curricular Guidelines for the Nursing

Care of Older Adults http://www.aacn.nche.edu/geriatric-

nursing/AACN_Gerocompetencies.pdf

➢ SCAN Foundation http://www.thescanfoundation.org/

➢ Stopping Elderly Accidents, Deaths and Injuries (STEADI)

https://www.cdc.gov/steadi/patient.html

https://www.youtube.com/watch?v=oeVfV8yOg_I


https://www.aging.ca.gov/Programs/

https://www.cdc.gov/aging/index.html

https://www.cdc.gov/steadi/index.html

https://www.cms.gov/About-CMS/Agency-Information/OMH/equity-initiatives/chronic-care-management.html

https://www.cms.gov/About-CMS/Agency-Information/OMH/equity-initiatives/chronic-care-management.html

https://consultgeri.org/

http://www.pioneernetwork.net/CultureChange/

http://www.aacn.nche.edu/elnec

http://frameworksinstitute.org/toolkits/aging/elements/items/aging_bp_quickstart.pdf

https://www.google.com/search?q=Growing+Old+in+a+new+Age-Truths+%26+Myths+of&rlz=1C1DIMA_enUS687US687&oq=Growing+Old+in+a+new+Age-Truths+%26+Myths+of&aqs=chrome..69i57.149977j0j4&sourceid=chrome&ie=UTF-8




https://hign.org/

https://www.healthypeople.gov/2020/topics-objectives/topic/older-adults

https://www.healthypeople.gov/2020/topics-objectives/topic/older-adults

http://www.milkeninstitute.org/centers/the-center-for-the-future-of-aging

https://www.ncoa.org/

http://www.nicheprogram.org/

http://www.n-r-c.com/survey-products/community-assessment-survey-for-older-adults/

http://www.n-r-c.com/survey-products/community-assessment-survey-for-older-adults/

https://www.medicare.gov/your-medicare-costs/help-paying-costs/pace/pace.html

https://www.medicare.gov/your-medicare-costs/help-paying-costs/pace/pace.html

http://www.aacn.nche.edu/geriatric-nursing/AACN_Gerocompetencies.pdf

http://www.aacn.nche.edu/geriatric-nursing/AACN_Gerocompetencies.pdf

http://www.thescanfoundation.org/

https://www.cdc.gov/steadi/patient.html


➢ Top 100 Wellness Sites for Seniors (RN Central) http://www.rncentral.com/nursing-

library/careplans/top_100_health_and_wellness_sites_for_seniors/

➢ Thomas, B. (2014). Second Wind: Navigating the Passage to a Slower, Deeper, and

More Connected Life. Simon & Shuster ebook.

➢ U.S. Health and Retirement Study http://hrsonline.isr.umich.edu/

➢ University of Iowa College of Nursing (2016). Evidence-based guidelines for older

adults. http://www.iowanursingguidelines.com/Evidence-Based-Practice-Guidelines-

s/144.htm

➢ World Health Organization Age Friendly Cities http://www.who.int/ageing/age-friendly-

world/en/

IX. Suggested Readings

Association for Gerontology in Higher Education [AGHE]. (2014). Gerontology competencies

for undergraduate & graduate education. Retrieved from


Beck, C., Buckwalter, K., & Evans, L. (2012). Geropsychiatric Nursing Competency

Enhancements. The Portal of Geriatrics Online Education. Retrieved from

https://www.pogoe.org/productid/20660

Bilotta, C., Bowling, A., Nicolini, P., Casè, A., Pina, G., Rossi, S. V., & Vergani, C. (2011).

Older people's quality of life (OPQOL) scores and adverse health outcomes at a one-year

follow-up. A prospective cohort study on older outpatients living in the community in

Italy. Health and Quality of Life Outcomes, 9, 72-72. doi:10.1186/1477-7525-9-72

Bing-Jonsson, P., Hofoss, D., Kirkevold, M., Bjørk, I. T., & Foss, C. (2016). Sufficient

competence in community elderly care? Results from a competence measurement of

nursing staff. BioMed Central Nursing, 15, 1-11. doi:10.1186/s12912-016-0124-z

Bowling, A., & Stenner, P. (2011). Which measure of quality of life performs best in older age?

A comparison of the OPQOL, CASP-19 and WHOQOL-OLD. Journal of Epidemiology

and Community Health, 65(3), 273-280. Retrieved from

https://scholar.google.com/scholar?hl=en&q=Which+measure+of+quality+of+life+perfor

ms+best+in+older+age%3F+A+comparison+of+the+OPQOL%2C+CASP-

19+and+WHOQOL-OLD&btnG=&as_sdt=1%2C5&as_sdtp=

Faria, D. F., Dauenhauer, J. A., & Steitz, D. W. (2010). Fostering social work gerontological

competencies: Qualitative analysis of an intergenerational service-learning

course. Gerontology & Geriatrics Education, 31(1), 92-113.

doi:10.1080/02701960903578378

Grady, P. A. (2011). Advancing the health of our aging population: A lead role for nursing

science. Nursing Outlook, 59(4), 207-9. Retrieved from http://0-


ftpubmed.oai.pubmedcentral.nih.gov.3197709&site=eds-live&scope=site

Holm, A. L., & Severinsson, E. (2014). Effective nursing leadership of older persons in the

community - a systematic review. Journal of Nursing Management, 22(2), 211-224 14p.

doi:10.1111/jonm.12076

Irving, P.H. (2015). Purposeful aging: A model for a new life course. Retrieved from

http://www.milkeninstitute.org/publications/view/760

http://www.rncentral.com/nursing-library/careplans/top_100_health_and_wellness_sites_for_seniors/

http://www.rncentral.com/nursing-library/careplans/top_100_health_and_wellness_sites_for_seniors/

http://hrsonline.isr.umich.edu/

http://www.iowanursingguidelines.com/Evidence-Based-Practice-Guidelines-s/144.htm

http://www.iowanursingguidelines.com/Evidence-Based-Practice-Guidelines-s/144.htm

http://www.who.int/ageing/age-friendly-world/en/

http://www.who.int/ageing/age-friendly-world/en/


https://www.pogoe.org/productid/20660

https://scholar.google.com/scholar?hl=en&q=Which+measure+of+quality+of+life+performs+best+in+older+age%3F+A+comparison+of+the+OPQOL%2C+CASP-19+and+WHOQOL-OLD&btnG=&as_sdt=1%2C5&as_sdtp






http://www.milkeninstitute.org/publications/view/760


Lange, J. W., Mager, D., Greiner, P. A., & Saracino, K. (2011). The ELDER project:

Educational model and three-year outcomes of a community-based geriatric education

initiative. Gerontology & Geriatrics Education, 32(2), 164-181.

doi:10.1080/02701960.2011.572056

Leung, A. Y. M., Chan, S. S. C., Kwan, C. W., Cheung, M. K. T., Leung, S. S. K., & Fong, D.

Y. T. (2011). Service learning in medical and nursing training: A randomized controlled

trial. Advances in Health Science Education, 17, 529-545. Retrieved from doi

10.1007/s10459-011-9329-9

Plowfield, L. A., Hayes, E. R., & Hall-Long, B. (2005). Using the Omaha system to document

the wellness needs of the elderly. Nursing Clinics of North America 40(4): 817-29. doi:

10.1016/j.cnur.2005.08.010

Quad Council of Public Health Nursing Organizations. (2011). Quad council competencies for

public health nurses. Retrieved from

http://www.achne.org/files/quad%20council/quadcouncilcompetenciesforpublichealthnur

ses.pdf

The American Geriatrics Society Expert Panel on Person-Centered Care. (2016). Person-centered

care: A definition and essential elements. Journal of the American Geriatrics

Society, 64(1), 15-18. doi:10.1111/jgs.13866

University of Minnesota School of Nursing (2012). Public Health Nursing Inventory &

Competencies (version G). Retrieved from

http://www.chhs.niu.edu/phncompetencies/PHNCI%20%20Version%20G%2011-20-

12.pdf

University of San Francisco. (2016). N653 Clinical Nurse Leader [CNL] Internship; N655 CNL

Quality Improvement & Outcomes Management; N654 CNL Leading Quality

Improvement Initiatives. San Francisco: School of Nursing and Health Professions.

Retrieved from https://www.usfca.edu/nursing/programs/graduate/masters/msn-

registered-nurses/program-details

Wagner, L. 2015. Adulthood and aging: Psychology 339. Department of Psychology.

University of San Francisco. Retrieved from USF professor of record.

http://www.achne.org/files/quad%20council/quadcouncilcompetenciesforpublichealthnurses.pdf

http://www.achne.org/files/quad%20council/quadcouncilcompetenciesforpublichealthnurses.pdf

http://www.chhs.niu.edu/phncompetencies/PHNCI%20%20Version%20G%2011-20-12.pdf

http://www.chhs.niu.edu/phncompetencies/PHNCI%20%20Version%20G%2011-20-12.pdf

https://www.usfca.edu/nursing/programs/graduate/masters/msn-registered-nurses/program-details

https://www.usfca.edu/nursing/programs/graduate/masters/msn-registered-nurses/program-details


Appendix F3

Gerontological Curriculum in CNL Role Courses

Summer and Fall 2017

Gerontological Lectures:

• Aging of America*

• Dementia and Alzheimer’s

• Biological Process of Aging

• Communicating with Older Adults

• Falls in Community-Dwelling Older Adults*

• Healthy People 2020 and 2017-21 California State Plan on Aging for Older Adults*

• Tidal Wave vs. Changing Demographics-Framing Ageism*

• Villages

Course Postings:

• Better Health While Aging website link

• Center for Disease Control Healthy Aging, 2015*

• Community-Dwelling Agencies, Services, and References links*

• Elder Orphans

• Elder Abuse article and website link*

• Frameworks website

• Institute for Health Improvement Patient Safety in the Home Report, 2017

• McMaster’s University Optimal Aging website

• National Council of Aging Evidence-Based Fall Prevention Programs, update July 2017*

*Summer 2017 Content


Appendix G

Gap Analysis

The Gap

Future State Current State Action

A gerontological community-

academic partnership (CAP)

will be an established program

within USF SONHP MSN

CNL program.

A gerontological community-

based internship and curriculum

for MSN Clinical Nurse Leaders

(CNL) students are currently not

available at University of San

Francisco’s School of Nursing

and Health Professions (USF

SONHP).

To develop, implement, and

evaluate gerontological

community-academic

partnerships for USF’s MSN

internship, incorporating

service-learning andragogy, to

meet the growing population

health needs of community-

dwelling older adults and

expand learning and workforce

opportunities for USF MSN

CNL students.

Closing the Gap

Future State Current State Action

Gerontology curriculum will

be available to faculty for use

in gerontology CAP.

No gerontology curriculum

within MSN CNL courses.

Develop and integrate

gerontological curriculum into

4+1 CNL courses.

Adequate number of

gerontological community

agencies for MSN CNL

internship placements.

Lack of community agency

placements serving gerontology

community-dwelling older

adults.

Recruit community agencies to

partner with USF SONHP for a

MSN CNL gerontological

community-based internship.

Evaluation tools will be

available to measure students’

experience within a

gerontological community

service-learning internship,

focused on the following:

• knowledge of older adults

• attitudes toward older

adults

• experiential reflections of

learnings

Test evaluation tools measuring

knowledge and attitudes

regarding the gerontology

population.

USF MSN graduates will be

prepared to lead the

coordination of care of


Lack of MSN students prepared

and knowledgeable regarding

community-dwelling older adult

health needs.

Prepare the future nursing

workforce to lead the

coordination of care for



adults and understand the

community resources to

support them to age in place.

adults, which will enable the

older adult population to age in

place.


Appendix H

1/16/2017; Updated 7-27-17; 10-15-17

ID # CAP Phases and StepsResponsible

Party(ies) Jan

Feb

Mar

Ap

r

May

Ju

n

Ju

l

Au

g

Sep

Oct

No

v

Dec

Jan

Feb

Mar

Ap

r

May

Ju

n

Ju

l

Au

g

Sep

Oct

No

v

Dec

Jan

Feb

Mar

Ap

r

May

Ju

n

Status

1 Discovery/Assessment Phase1.1 Determine DNP Project FSD/Advisor Completed

1.2 Conduct gap analysis FSD Completed

1.3 Begin lit review of CAPS & SL FSD Completed

2 Dream & Network Phase2.1 Illicit faculty input FSD Completed

2.2 Identify & cnnect w/ initial community partners FSD Completed

3

3.1 Incorporate MSN leadership feedback into project FSD Completed

3.2 Conduct lit review for gero competencies FSD Completed

3.3 Develop initial course competencies FSD Completed

3.4 Procure student eval tools permission FSD Completed

3.5 Continue lit review for CAPs and project rationale FSD Completed

3.6 Refine SOD, CAP steps, budget, Gantt, & SWOT FSD/Advisor Completed

3.7 Consult with USF expert gero & partnership faculty FSD Ongoing

3.8 Finalize gero course description & objectives FSD Completed

3.9 Complete inventory of community partners FSD Ongoing

3.11

Develop joint measurable outcomes w/ community

partnersFSD/ Partners

Completed

3.12 Obtain MOUs with community partners J.Bartz&FSD Completed

3.13 Create community partners' & academia's eval tools FSD Completed

3.14 Create reflection questions for student assignments FSD Completed

3.15 Create data management tools, process & analysis FSD/RA Completed

3.16 Merge gero content w/ CNL Role courses FSD Ongoing

4

4.1 Clarify CAP logistices & expectations FSD Completed

4.2 Conduct student orientation FSD Completed

4.3 Assign preceptors FSD/Partners Completed

4.4 Review CAP goals and expectations with students FSD Completed

4.5 Complete students' pre-quizzes FSD/Students Completed

4.6 Begin semester gero CAP FSD/Students Completed

4.7 Communicate w/ partners on continuous basis FSD Ongoing

5

5.1 Complete students' post-quizzes FSD/Students Aug Completed

5.2 Conduct community agency's & SONHP's evaluation FSD/Partners Aug Completed

5.3 Share semester's evaluation data & analysis FSD Aug Completed

5.4 Monitor and document progress/lessons learned FSD/Partners Ongoing

5.5 Implement improvements based on metrics FSD/Partners Ongoing

5.6 Collectively celebrate achievements FSD/Partners Ongoing

5.7 Determine ongoing commitment & sustainability FSD/Partners Ongoing

5.8 Students share CNL QI project w/ partners FSD/Students Pending

Cooperation Phase: Execute the Delivery

Evaluation & Collaboration Phase: Sustainability

MSN CNL Gerontological (Gero) Community-Academic Partnership (CAP) GANTT Chart2016 2017 2018

Design & Coordination Phase


Appendix I

Work Breakdown Structure:

MSN CNL Gerontological (Gero) Community-Academic Partnership (CAP)

Academic Partner Community Partner Students Gero Curriculum

Direction &

authorization from

Dean & Assist. Dean to

create MSN CAP

Determination of

potential partners

Communication with

4+1 Program Director

and MSN faculty

Review of literature

Meeting with MSN

faculty to get buy in

and support

Contacting and meeting

with potential partners

Determination of

cohort and number of

students

Consultation w/ USF

gero faculty

Determination of 4+1

MSN students to

immerse in CAP

Commitment from

partners in specific

microsystems within

agency

Place students in

community setting

Determination of NLN

ACES as framework

Ongoing

communication with

Assist Dean & DNP

Advisor to finalize

CAP

Partners'

communication re

student placement and

feedback on evaluation

metrics based on

literature review

Evaluation by students

& reporting

Development of

curriculum

Evaluation results

shared with SONHP

leadership and faculty

Ongoing meetings with

community partners

and students

Determination of how

to incorporate gero

curriculum into CNL

role courses

Evaluation & reporting

back to community

partners

Delivered lectures

during in-class

sessions, 4-6

times/semester


Appendix J

SWOT Analysis for an MSN CNL Gerontological CAP

Strengths Weaknesses

❖ Correlation with USF mission

❖ SONHP culture of expansion & promoting life-long learners

❖ SONHP stakeholder commitment

❖ Gerontological knowledge experts at USF

❖ Partnership knowledge and experience with community

partners at USF

❖ Evidence in literature re: students’ knowledge & attitudes ↑

with education in undergraduate CAPs

❖ Broad spectrum of gerontological services among

community partners

❖ Reliable and valid student evaluation tools

❖ Lack of responsiveness from potential partner(s)

❖ New program/pilot

❖ Lack of evidence in literature of Gerontological CAPs at the

graduate level

❖ Lack of interest & commitment from community agencies

❖ Lack of faculty’s interest to teach and sustain CAP

Opportunities Threats

❖ Learnings from community partners

❖ Students learn to lead and develop collaborative community-

based improvement projects

❖ Expand gerontological community-based nursing workforce

❖ Enhance job opportunities for USF graduates

❖ Inter-professional collaboration & education

❖ Spread model to other SONHP programs

❖ Marketing tool for a new SONHP program

❖ Increase the number of relationships between SONHP and

community partners

❖ Community agencies and academia mutual support, benefit,

and commitment

❖ Breakdown in communication

❖ Inadequate understanding of agency’s role and

responsibilities

❖ Turnover of key stakeholders at community agency

❖ Community partner breakdown due to early withdrawal

❖ Resources to sustain partnership become unavailable

❖ Lack of preceptor(s) in community agency

❖ Lack of faculty support/buy-in

❖ Students’ lack of interest/passion for older adults

❖ Interpersonal conflicts between student and preceptor


Appendix K

Responsibility/Communication Matrix


Appendix L

Financial Benefit: Cost Avoidance and ROI

Cost of Care Avoidance 2016 Rates

Fall Hospitalization for One > 65 yo (CA OSHPD [San Mateo County], 2012=$88,471) Inflation/CPI 92,810$

Inc # of AdmitsTuition/Student

Potential ROI to School: 1% increase in 4+1/yr. 1 $44,000 44,000$

# of Agencies

RN Hourly

Salary

Hours: QI

Project

Potential ROI to Agency: 13 60$ 200 156,000$

Total Financial Benefit: Cost Avoidance and ROI 292,810$

Expenses

Immersion of 11 Graduate Nursing Sudents into Gero CAP Credits/Hrs. $/Credit or Hrs. # of Staff # Semesters

Faculty

N654, CNL 1: Leading QI Initiatives 2 2,650$ 1 2 10,600$

N655, CNL 2: QI & Outcomes Management 3 2,650$ 1 2 15,900$

N653, CNL 3: QI Project 3 2,650$ 1 2 15,900$

Mileage/travel 2,000$

Research Assistants 300 15$ 2 9,000$

Course Materials: paper, copying, flyers 3,000$

# of people # of partner mtgs.* Hrly rate

Partner Meetings 2 20 $75 3,000$

Total Expenses 59,400$

Cost Avoidance, Return on Investment, & Expense Budget

Net of Cost Avoidance and ROI for Gerontological Community-Based Internship to USF SONHP, Community

Agencies, and One Community-Dwelling Older Adult 233,410$


Appendix M1




Appendix M2

Aging Semantic Differential Tool

Below are listed a series of polar adjectives accompanied by a scale of 1 through 7. You are asked to

place a check mark along the scale at a point that best represents your judgement about older adults.

Mark each item as a separate and independent judgement. Do not worry or puzzle over individual terms.

Do not try to remember how you have marked earlier items even though they may seem to have been

similar. It is your first impression or immediate feeling that is most important. Please be sure to mark

each item on the scale.

1 2 3 4 5 6 7

Progressive ______ ______ ______ ______ ______ ______ ______ Old-fashioned

Consistent ______ ______ ______ ______ ______ ______ ______ Inconsistent

Independent ______ ______ ______ ______ ______ ______ ______ Dependent

Rich ______ ______ ______ ______ ______ ______ ______ Poor

Generous ______ ______ ______ ______ ______ ______ ______ Selfish

Productive ______ ______ ______ ______ ______ ______ ______ Unproductive

Busy ______ ______ ______ ______ ______ ______ ______ Idle

Secure ______ ______ ______ ______ ______ ______ ______ Insecure

Strong ______ ______ ______ ______ ______ ______ ______ Weak

Healthy ______ ______ ______ ______ ______ ______ ______ Unhealthy

Active ______ ______ ______ ______ ______ ______ ______ Passive

Handsome ______ ______ ______ ______ ______ ______ ______ Ugly

Cooperative ______ ______ ______ ______ ______ ______ ______ Uncooperative

Optimistic ______ ______ ______ ______ ______ ______ ______ Pessimistic

Satisfied ______ ______ ______ ______ ______ ______ ______ Dissatisfied

Expectant ______ ______ ______ ______ ______ ______ ______ Resigned

Flexible ______ ______ ______ ______ ______ ______ ______ Inflexible

Hopeful ______ ______ ______ ______ ______ ______ ______ Dejected

Organized ______ ______ ______ ______ ______ ______ ______ Disorganized

Happy ______ ______ ______ ______ ______ ______ ______ Sad

Friendly ______ ______ ______ ______ ______ ______ ______ Unfriendly

Neat ______ ______ ______ ______ ______ ______ ______ Untidy

Trustful ______ ______ ______ ______ ______ ______ ______ Suspicious

Self-reliant ______ ______ ______ ______ ______ ______ ______ Dependent

Liberal ______ ______ ______ ______ ______ ______ ______ Conservative

Certain ______ ______ ______ ______ ______ ______ ______ Uncertain

Tolerant ______ ______ ______ ______ ______ ______ ______ Intolerant

Pleasant ______ ______ ______ ______ ______ ______ ______ Unpleasant


Ordinary ______ ______ ______ ______ ______ ______ ______ Eccentric

Aggressive ______ ______ ______ ______ ______ ______ ______ Defensive

Exciting ______ ______ ______ ______ ______ ______ ______ Dull

Decisive ______ ______ ______ ______ ______ ______ ______ Indecisive

Rosencranz, H. A., & McNevin, T. E. (1969). A factor analysis of attitudes toward the aged. United States, North

America: Oxford University Press.


Appendix M3

Student Reflection Questions

1. What opportunities have you had to contribute to the microsystem?

2. What new insights have you gained from the service-learning practicum?

3. What new knowledge/skills have you learned from working with an interdisciplinary

team?

4. What new knowledge have you gained regarding community or microsystem resources

that address social or population health problems?


Appendix M4

University of San Francisco School of Nursing and Health Professions

Gerontological Community-Academic Partnership for MSN Students

Community Partner Survey

1. Collaborative experience of formulating goals together for the community-academic

partnership with USF School of Nursing and Health Professions

Strongly agree Agree Disagree Strongly disagree Not applicable

2. Ongoing collaboration and coordination occurred with USF School of Nursing and

Health Professions


3. Student’s role and rationale for placement was shared with the community agency


4. If an issue or conflict arose, response from the assigned faculty was timely


5. If an issue or conflict arose, faculty’s response was appropriate to the situation/issue


6. If a problem or conflict arose, faculty or students worked collaboratively to address the

issue with you


7. Student demonstrated consistent initiative


8. Student was consistently dependable


9. Student’s collegiality with staff and clients was appropriate to the situation/work

environment


10. Please indicate benefits to your agency due to this community-academic partnership:

___________________________________________________________________________

Comments:

___________________________________________________________________________

Optional:

Name__________________________________Agency_____________________________